Can Thyroid Ultrasonography Predict Substernal Extension or Tracheal Compression in Goiters?

Abstract

Purpose To determine whether an ultrasonography (US)-defined thyroid volume can accurately predict substernal extension or tracheal narrowing. Methods After research ethics approval, we identified patients with thyroid nodules investigated with both US and computed tomography (CT). Reviewers assigned scores for both substernal extension and tracheal compression on CT using pre-established classification systems. Statistical analysis with receiver operating characteristic curve analysis was performed to find the US-determined thyroid volume thresholds that correlated with each substernal extension and tracheal compression. Results This study included 120 patients (mean age 63.4 years; SD ± 15.9; 67% female). Thirty-five patients (29%) had substernal extension. The mean US total thyroid gland volume in patients with and without substernal extension were 92.4 and 37.6 cm3, respectively ( P < .001). 86% of patients with substernal extension had tracheal narrowing vs. 27% of patients without substernal extension ( P < .0001). A cutoff dominant gland volume of ≥37.5 cm3 showed 83% sensitivity and 79% specificity for substernal extension (area under the curve [AUC] = 0.84). A total thyroid gland volume threshold of ≥37.8 cm3 showed 89% sensitivity and 87% specificity for any degree of tracheal narrowing (AUC = 0.90). Conclusions This study suggests that US volumes may be used as a predictor to identify those patients with thyroid enlargement who are most at risk of substernal extension and tracheal compression and who may benefit from preoperative CT imaging for optimal surgical and anesthetic planning.

A critical update on the management of retrosternal goiter

“…, supine, a roll under the shoulders, and by hyperextending the neck) has an excellent sensitivity (98%) and a variable specificity (46.7-91.1%) to identify substernal extension 36 . Another interesting result is that, in the absence of the Pemberton's sign, the probability of getting a false positive finding of a substernal extension was only 4%, and this is quite relevant in the context of low-income countries where the availability of CT scan is scarce 3633 , an 89% sensitivity and 87% specificity for any degree of tracheal narrowing were registered (AUC = 0.90) 37 .…”

Thyroid gland parameters of mature women living in Saint-Petersburg

“…Широкое внедрение ультразвуковых и лучевых методов исследования в клинике расширило возможности морфологов в изучении параметров щитовидной железы в разных возрастных периодах. На сегодняшний день ультразвуковая диагностика является самым доступным исследованием щитовидной железы, так как оборудование для сонографии имеется практически в каждом медицинском учреждении [21,28]. Применение современных ультразвуковых аппаратов с высокочувствительными линейными датчиками позволяет получать изображения щитовидной железы с высоким разрешением.…”