Surgical approach decision-making based on the CT-guided retrosternal goiter grading

Abstract

Retrosternal goiter compromises a wide range of prevalence rate in various geographical regions from 0.05 to 30.4 %. Retrosternal goiters produce compressive symptoms such as dyspnea and dysphagia. The Purpose of this study was to determine the type of non-cervical approach with the use of Computed Tomography (CT) findings. This study was conducted on 15 patients administered Imam Khomeini Hospital (Ahvaz, Iran) from 2009 to 2012. From 92 clinically goiterous patients, 16 patients with extension of goiter below sternal notch in chest CT scan were enrolled. Inclusion criteria were visible thyroid tissue below the sternal notch. Patients have been studied in terms of chief complaint, age, sex, surgical approach, surgical complications and histology. Surgery begins with cervical approach and in the face of necessity non-cervical approach was used. A CSI classification system defined substernal goiter in the cranio-caudal dimension as: grade 1 (above aortic arch), grade 2 (level of aortic arch), and grade 3 (below aortic arch). We used CSI classification system for our study. CT scan should be done in three dimensional techniques with intravenous contrast. Chi-square tests are used for comparison of grading and results. P-values equal or less than 0.05 is considered statistically significant. Ten female and six male patients with a mean age of 51 years undergone surgery. Retrosternal goiter prevalence was 17%. Overall, 94% patients operated by cervical and non-cervical approach, and the rest 0.06% exposed only to non-cervical approach. According to the CT findings, retrosternal goiter grades 3B and 3C need simultaneous non-cervical and cervical approaches.