The role of imaging in the diagnosis and surgical approach of substernal goitre
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Hellenic Journal of Surgery (2015) 87:1, 11-13
The Role of Imaging in the Diagnosis and Surgical Approach of Substernal Goitre S. Fountoulakis
Abstract Substernal goitre is a disorder of the thyroid gland that frequently requires surgical treatment due to potential compression of adjacent structures and for the exclusion of malignancy. Cross-sectional imaging plays an important role both in the diagnosis as well as in the classification of substernal goitre. Even though a cervical surgical approach is sufficient in the vast majority of cases, the application of goitre classification systems may possibly indicate the need for a sternotomy/thoracotomy. A consensus on the definition of substernal goitre is fundamental to allow meta-analyses to be conducted. Key words: Substernal goitre; retrosternal goitre; surgical approach; classification of substernal goitre
Introduction Substernal goitre is encountered in 0.02% of the general population and its incidence among all goitres varies between 2 and 15%, depending on its definition [1,2]. The terms retrosternal, mediastinal and intrathoracic goitre are also used in the literature. In most cases (99%), substernal goitre is secondary, originating from a normotopic thyroid gland and connected to it with thyroid tissue, vasculature or a thin fibrous band, the latter making its diagnosis challenging. Primary substernal goitre is rare. It is defined as the presence of ectopic, retrosternal thyroid tissue, receiving its blood supply from mediastinal vessels, without any connection with the normotopic thyroid [1-3].
Discussion Surprisingly, there is no consensus regarding the definition of substernal goitre. Numerous definitions have been used in the past, most of which were based on anatomical referrals such as the aortic arch, bodies of thoracic vertebrae, entrance of the thoracic inlet, tracheal carina, sternal notch or manubrium sterni. Two of the most prevalent definitions in the literature include Katlic’s definition (at least 50% of the goitre lies below sternal notch) and the clinical definition (a S. Fountoulakis, MD, PhD Clinic of Endocrinology and Diabetes Center, General Hospital of Athens “G. Gennimatas”, Athens, Greece Corresponding author: S. Fountoulakis, Clinic of Endocrinology and Diabetes Center, Athens General Hospital “G. Gennimatas”, 154 Mesogion Avenue 11527 Tel:+302107768283, Fax:+302107779146 e-mail address: [email protected] Received 16 May 2014; Accepted 30 Oct 2014 Hellenic Journal of Surgery 87
part of the goitre remains below the sternal notch, with the patient in the surgical position) which is also adopted in the 2014 statement of the American Thyroid Association (ATA) regarding the optimal surgical management of goitre [4,5]. Several studies have been conducted regarding the surgical approach of substernal goitre. In 90-99% of cases, a cervical approach is sufficient [1-3,6-9]. A lower percentage of cervical approach (84%) was reported in the systematic review of Huins et al., whereas a cervical approach plus manubriotomy was performed in 3.
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