World Journal of Endocrine Surgery

Register      Login

VOLUME 13 , ISSUE 2 ( May-August, 2021 ) > List of Articles

Original Article

Diagnostic Accuracy Study of CT Scan in Predicting the Need for Sternotomy in Management of Substernal Goiters

Ana Torre, João Varanda, Bárbara Castro, Susana Graça, Antónia Póvoa, Carlos Soares, José Vieira, Manuel Oliveira

Keywords : AUC, Diagnostic test accuracy study, Likelihood ratio, ROC curve, Substernal goiter, Thyroid

Citation Information : Torre A, Varanda J, Castro B, Graça S, Póvoa A, Soares C, Vieira J, Oliveira M. Diagnostic Accuracy Study of CT Scan in Predicting the Need for Sternotomy in Management of Substernal Goiters. World J Endoc Surg 2021; 13 (2):37-41.

DOI: 10.5005/jp-journals-10002-1402

License: CC BY-NC 4.0

Published Online: 31-01-2022

Copyright Statement:  Copyright © 2021; The Author(s).


Abstract

Aim and objective: To find a new predictor of sternotomy with thyroid gland measurements in CT scan. Materials and methods: We performed a retrospective review of our endocrine surgery database between January 2012 and October 2017. We identified 123 patients treated for substernal goiter, 7 required an extra-cervical approach, and 116 a cervical one. The measurement of thyroid gland craniocaudal length, larger diameter of mediastinal component, and the diameter of thoracic inlet were performed in all patients with substernal goiter. ROC analysis was performed to determine craniocaudal length and mediastinal thyroid mass diameter cutoff value, which significantly predict the need of an extra-cervical approach for substernal goiter. Results: The craniocaudal length of thyroid mass below thoracic inlet ≥34.5 mm and the diameter of mediastinal component ≥53.5 mm were significantly associated with the need of an extra-cervical approach ( p = 0.005 and p = 0.015, respectively). We also analyzed the ratio between mediastinal component diameter and thoracic inlet diameter and the ROC analysis of this ratio identified ≥1.24 as the cutoff value with maximum accuracy. A ratio ≥1.24 was significantly associated with the need of sternotomy ( p = 0.03) with a likelihood ratio of 9.09 (IC 4.32-19.51). Conclusion: The ratio between mediastinal component diameter and thoracic inlet ≥1.24 was a significant determining factor for sternotomy. Clinical significance: The ratio we suggest based in CT scan measurements allows the identification of patients who may need sternotomy, permitting referral patients to another hospital with thoracic surgeons and prior preparation of the surgical team. Furthermore, these measurements can be obtained by a trained head and neck surgeon.


HTML PDF Share
  1. Huins CT, Georgalas C, Mehrzad H, et al. A new classification system for retrosternal goitre based on a systematic review of its complications and management. Int J Surg 2008;6(1):71–76. DOI: 10.1016/j.ijsu.2007.02.003
  2. Allo MD, Thompson NW. Rationale for the operative management of substernal goiters. Surgery 1983;94:969–977.
  3. Sitges-Serra A, Sancho JJ. Surgical management of recurrent and intrathoracic goiters. In: Clark OH, Duh Q-Y, Kebebew E (Eds). Textbook of Endocrine Surgery, 2nd edition. Philadelphia: Elsevier Saunders; 2005. pp. 304–17. DOI: 10.1016/B978-0-7216-0139-7.50037-5
  4. Katlic MR, Wang CA, Grillo HC. Substernal goiter. Ann Thorac Surg 1985;39:391–399. DOI: 10.1016/s0003-4975(10)62645-8
  5. Gittoes NJ, Miller MR, Daykin J, et al. Upper airways obstruction in 153 consecutive patients presenting with thyroid enlargement. BMJ 1996;312:484. DOI: 10.1136/bmj.312.7029.484
  6. Hedayati N, McHenry CR. The clinical presentation and operative management of nodular and diffuse substernal thyroid disease. Am Surg 2002;68:245–251.
  7. Netterville JL, Coleman SC, Smith JC, et al. Management of substernal goiter. Laryngoscope 1998;108:1611–1617. DOI: 10.1097/00005537-199811000-00005
  8. Cichoń S, Anielski R, Konturek A, et al. Surgical management of mediastinal goiter: risk factors for sternotomy. Langenbecks Arch Surg 2008;393:751–757. DOI: 10.1007/s00423-008-0338-y
  9. Cohen JP. Substernal goiters and sternotomy. Laryngoscope 2009;119:683–688. DOI: 10.1002/lary.20102
  10. Ahmed Bichoo R, Mayilvaganan S. Demographics, disparities, and outcomes in substernal goiters in the United States. Am J Surg 2017;213(1):203. DOI: 10.1016/j.amjsurg.2016.04.015
  11. Testini M, Gurrado A, Avenia N, et al. Does mediastinal extension of the goiter increase morbidity of total thyroidectomy? A multicenter study of 19,662 patients. Ann Surg Oncol 2011;18:2251–2259. DOI:10.1245/s10434-011-1596-4
  12. Qureishi A, Garas G, Tolley N, et al. Can pre-operative computed tomography predict the need for a thoracic approach for removal of retrosternal goitre? Int J Surg 2013;11:203–208. DOI: 10.1016/j.ijsu.2013.01.006
  13. Grainger J, Saravanappa N, D’Souza A,et al. The surgical approach to retrosternal goiters: the role of computerized tomography. Otolaryngol Head Neck Surg 2005;132:849–851. DOI: 10.1016/j.otohns.2005.01.039
  14. Mercante G, Gabrielli E, Pedroni C, et al. CT cross-sectional imaging classification system for substernal goiter based on risk factors for an extracervical surgical approach. Head Neck 2011;33(6):792–799. DOI: 10.1002/hed.21539
  15. Di Crescenzo V, Vitale M, Valvano L, et al. Surgical management of cervico-mediastinal goiters: our experience and review of the literature. Int J Surg 2016;28(Suppl 1): S47–S53. DOI: 10.1016/j.ijsu.2015.12.048
  16. de Perrot M, Fadel E, Mercier O, et al. Surgical management of mediastinal goiters: when is a sternotomy required? Thorac Cardiovasc Surg 2007; 55: 39–43. DOI: 10.1055/s-2006-924440
  17. Sormaz IC, Uymaz DS, Işcan AY, et al. The Value of Preoperative Volumetric Analysis by Computerised Tomography of Retrosternal Goiter to Predict the Need for an Extracervical Approach. Balkan Med J 2018;35:36–42. DOI: 10.4274/balkanmedj.2017.0161
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.