Volumetric Analysis is Useful for Predicting Use of Sternotomy During Retrosternal Thyroidectomy
Surgical removal is the recommended treatment for retrosternal goitre. This can be successfully achieved through a cervical incision in most cases, however occasionally a thoracic approach is required. Being able to predict the need for sternotomy would improve logistical efficiency, saving time and money, and allow patients to be better informed preoperatively. The aim of this study was to determine whether analysing thyroid volume on preoperative CT scans could help predict the use of sternotomy. To the best of our knowledge this is the first study investigating this. A retrospective study was conducted on 64 patients who underwent thyroidectomy for retrosternal goitre at the Golden Jubilee National Hospital, Scotland, between 2012-2016. Patient demographic information and pathological reports were obtained from databases. Preoperative CT scans were used for volumetric analysis. The total volume, the volume inferior to the level of the sternal notch (intrathoracic volume), and the anteroposterior diameter of the thoracic inlet were measured. An index of relative goitre size was calculated by dividing intrathoracic volume by thoracic inlet diameter. Mann-Whitney U tests and Fisher’s exact tests were used to analyse continuous and categorical variables respectively. Goitres were successfully removed by a cervical incision alone in 55 patients, while thoracic intervention was needed in 9 cases (13.3%). Intrathoracic volume (p=0.0091) and volumetric index (p=0.0033) were significantly larger in those requiring sternotomy. Total volume was not significantly different. All other variables measured were similar in both groups. Our results suggest that assessing intrathoracic volume of goitre is useful in predicting the need for sternotomy. However, it is not able to completely rule out thoracic intervention. The volumetric index is likely to be a better predictor than volume alone.
Sanjeet Avtaar Singh,
Volumetric Analysis is Useful for Predicting Use of Sternotomy During Retrosternal Thyroidectomy, Advances in Surgical Sciences.
Vol. 5, No. 2,
2017, pp. 15-25.
Lahey, F. H. & Swinton, N. W. 1934. Intrathoracic goiter. Surgery Gynecology & Obstetrics, 59, 627-637.
Netterville, J. L., Coleman, S. C., Smith, J. C., Smith, M. M., Day, T. A. & Burkey, B. B. 1998. Management of substernal goiter. Laryngoscope, 108, 1611-1617.
Bizakis, J., Karatzanis, A., Hajiioannou, J., Bourolias, C., Maganas, E., Spanakis, E., Bizaki, A. & Velegrakis, G. 2008. Diagnosis and management of substernal goiter at the University of Crete. Surgery Today, 38, 99-103.
Coskun, A., Yildirim, M. & Erkan, N. 2014. Substernal Goiter: When is a Sternotomy Required? International Surgery, 99, 419-425.
Cohen, J. R. 2009. Substernal Goiters and Sternotomy. Laryngoscope, 119, 683-688. Coskun, A., Yildirim, M. & Erkan, N. 2014. Substernal Goiter: When is a Sternotomy Required? International Surgery, 99, 419-425.
Testini, M., Gurrado, A., Avenia, N., Bellantone, R., Biondi, A., Brazzarola, P., Calzolari, F., Cavallaro, G., De Toma, G., Guida, P., Lissidini, G., Loizzi, M., Lombardi, C. P., Piccinni, G., Portincasa, P., Rosato, L., Sartori, N., Zugni, C. & Basile, F. 2011. Does Mediastinal Extension of the Goiter Increase Morbidity of Total Thyroidectomy? A Multicenter Study of 19,662 Patients. Annals of Surgical Oncology, 18, 2251-2259.
White, M. L., Doherty, G. M. & Gauger, P. G. 2008. Evidence-based surgical management of substernal goiter. World Journal of Surgery, 32, 1285-1300.
Rios, A., Rodriguez, J. M., Balsalobre, M. D., Tebar, F. J. & Parrilla, P. 2010. The value of various definitions of intrathoracic goiter for predicting intra-operative and postoperative complications. Surgery, 147, 233-238.
El Oueriachi, F., El Hammoumi, M. M., Arsalane, A., Slaoui, O. & Kabiri, E. 2014. Primary mediastinal goiters. Springerplus, 3, 5.
Rugiu, M. G. & Piemonte, M. 2009. Surgical approach to retrosternal goitre: do we still need sternotomy? Acta Otorhinolaryngologica Italica, 29, 331-338.
Chen, A. Y., Bernet, V. J., Carty, S. E., Davies, T. F., Ganly, I., Inabnet, W. B. & Shaha, A. R. 2014. American Thyroid Association Statement on Optimal Surgical Management of Goiter. Thyroid, 24, 181-189.
Raffaelli, M., De Crea, C., Ronti, S., Bellantone, R. & Lombardi, C. P. 2011. SUBSTERNAL GOITERS: INCIDENCE, SURGICAL APPROACH, AND COMPLICATIONS IN A TERTIARY CARE REFERRAL CENTER. Head and Neck-Journal for the Sciences and Specialties of the Head and Neck, 33, 1420-1425.
Cichon, S., Anielski, R., Konturek, A., Baczynski, M., Cichon, W. & Orlicki, P. 2008. Surgical management of mediastinal goiter: risk factors for sternotomy. Langenbecks Archives of Surgery, 393, 751-757.
Khan, M. N., Goljo, E., Owen, R., Park, R. C. W., Yao, M. & Miles, B. A. 2016. Retrosternal Goiter: 30-Day Morbidity and Mortality in the Transcervical and Transthoracic Approaches. Otolaryngology-Head and Neck Surgery, 155, 568-574.
Rolighed, L., Ronning, H. & Christiansen, P. 2015. Sternotomy for substernal goiter: retrospective study of 52 operations. Langenbecks Archives of Surgery, 400, 301-306.
Casella, C., Pata, G., Cappelli, C. & Salerni, B. 2010. PREOPERATIVE PREDICTORS OF STERNOTOMY NEED IN MEDIASTINAL GOITER MANAGEMENT. Head and Neck-Journal for the Sciences and Specialties of the Head and Neck, 32, 1131-1135.
Malvemyr, P., Liljeberg, N., Hellstrom, M. & Muth, A. 2015. Computed tomography for preoperative evaluation of need for sternotomy in surgery for retrosternal goitre. Langenbecks Archives of Surgery, 400, 293-299.
Nankee, L., Chen, H., Schneider, D. F., Sippel, R. S. & Elfenbein, D. M. 2015. Substernal goiter: when is a sternotomy required? Journal of Surgical Research, 199, 121-125.
Qureishi, A., Garas, G., Tolley, N., Palazzo, F., Athanasiou, T. & Zacharakis, E. 2013. Can pre-operative computed tomography predict the need for a thoracic approach for removal of retrosternal goitre? International Journal of Surgery, 11, 203-208.
Mckenzie, G. A. G. & Rook, W. 2014. Is it possible to predict the need for sternotomy in patients undergoing thyroidectomy with retrosternal extension? Interactive Cardiovascular and Thoracic Surgery, 19, 139-143.
Riffat, F., Del Pero, M. M., Fish, B. & Jani, P. 2013. Radiologically Predicting When a Sternotomy May Be Required in the Management of Retrosternal Goiters. Annals of Otology Rhinology and Laryngology, 122, 15-19.
Sari, S., Erbil, Y., Ersoz, F., Saricam, G., Salmaslioglu, A., Issever, H. & Ozarmagan, S. 2012. Predictive Value of Thyroid Tissue Density in Determining the Patients on Whom Sternotomy Should be Performed. Journal of Surgical Research, 174, 312-318.
Mercante, G., Gabrielli, E., Pedroni, C., Formisano, D., Bertolini, L., Nicoli, F., Valcavi, R. & Barbieri, V. 2011. CT CROSS-SECTIONAL IMAGING CLASSIFICATION SYSTEM FOR SUBSTERNAL GOITER BASED ON RISK FACTORS FOR AN EXTRACERVICAL SURGICAL APPROACH. Head and Neck-Journal for the Sciences and Specialties of the Head and Neck, 33, 792-799.
Latini, F., Larsson, E.-M. & Ryttlefors, M. 2015. Rapid and Accurate MRI Segmentation of Peritumoral Brain Edema in Meningiomas. Clinical Neuroradiology, 1-8.
Folio, L. R., Sandouk, A., Huang, J. X., Solomon, J. M. & Apolo, A. B. 2013. Consistency and Efficiency of CT Analysis of Metastatic Disease: Semiautomated Lesion Management Application Within a PACS. American Journal of Roentgenology, 201, 618-625.
Katlic, M. R., Wang, C. & Grillo, H. C. 1985. SUBSTERNAL GOITER. Annals of Thoracic Surgery, 39, 391-399.
Chang, C. Y., Hong, Y. C., Chung, P. C. & Tseng, C. H. 2011. A Neural Network for Thyroid Segmentation and Volume Estimation in CT Images. Ieee Computational Intelligence Magazine, 6, 43-55.
Chen, A., Niermann, K. J., Deeley, M. A. & Dawant, B. M. 2012. Evaluation of multiple- atlas-based strategies for segmentation of the thyroid gland in head and neck CT images for IMRT. Physics in Medicine and Biology, 57, 93-111.
Bhargav, P. R., Amar, V., Mahilvayganan, S. & Nanganandadevi, V. 2016. Feasibility of thoracoscopic approach for retrosternal goitre (posterior mediastinal goitre): Personal experiences of 11 cases. Journal of Minimal Access Surgery, 12, 240-244.
Gupta, P., Lau, K. K. W., Rizvi, I., Rathinam, S. & Waller, D. A. 2014. Video assisted thoracoscopic thyroidectomy for retrosternal goitre. Annals of the Royal College of Surgeons of England, 96, 606-608.