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Mediastinal goiters. The need for an aggressive approach
L E Sanders1, R L Rossi, D M Shahian
1Department of General Surgery, Lahey Clinic Medical Center, Burlington, Mass. 01805.
Archives of Surgery (Chicago, Ill. : 1960)
|May 1, 1992
Summary
Substernal goiters often present with compressive symptoms and have a significant risk of malignancy. Surgical resection via cervical incision is safe and recommended for all substernal goiters.
Area of Science:
- Endocrinology
- Surgical Oncology
- Thoracic Surgery
Background:
- Substernal goiters, masses extending into the chest, can cause compressive symptoms.
- Malignancy risk and diagnostic challenges are significant concerns in substernal goiter management.
Purpose of the Study:
- To analyze the clinical presentation, diagnostic workup, surgical removal techniques, malignancy rates, and outcomes in patients with substernal goiters.
Main Methods:
- Retrospective review of 52 patients diagnosed with substernal goiters.
- Evaluation of diagnostic imaging modalities including chest X-ray, CT, MRI, and thyroid scans.
- Analysis of fine-needle aspiration (FNA) utility and surgical outcomes.
Main Results:
- 50% of patients were asymptomatic; 50% experienced compressive symptoms.
- Computed tomography (CT) and magnetic resonance imaging (MRI) were the most effective diagnostic tools.
- Malignancy was detected in 17% of cases (21% including incidental papillary carcinomas), often missed by FNA.
- Surgical resection via cervical incision was safe, with low morbidity and no mortality.
Conclusions:
- Substernal goiter necessitates surgical intervention due to compression risk, potential for malignancy, and safe resection outcomes.
- Advanced imaging (CT/MRI) is crucial for diagnosis; FNA is limited.
- Early surgical management is indicated for substernal goiters regardless of symptoms.