Is thymectomy in non-thymomatous myasthenia gravis of any benefit?

Díaz, Andrés; Black, Elizabeth; Dunning, Joel

doi:10.1093/icvts/ivt510

Cited by 51 publications

(40 citation statements)

References 17 publications

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“…Thymomas are benign or low-grade malignant tumours of the thymic epithelium and represent up to half of all neoplasms of the anterior mediastinum [1][2][3][4][5][6]. The histological classification proposed by the World Health Organization (WHO) and the Masaoka-Koga staging system, based on surgical findings, is currently used for treatment planning and significantly correlate with prognosis [1][2][3][4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

“…The histological classification proposed by the World Health Organization (WHO) and the Masaoka-Koga staging system, based on surgical findings, is currently used for treatment planning and significantly correlate with prognosis [1][2][3][4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

“…Indeed, in nonthymomatous MG, the clinical efficacy of thymectomy has been questioned because the evidence supporting its use is not clear and has largely been based on single-institution retrospective, observational studies. 3 Currently, although no uniformly accepted guidelines are available, thymectomy is believed to be suitable for patients with generalized MG under 50 years with antiAChR antibodies and TLH, as an option to increase the probability of clinical improvement or complete stable remission. 16 Contrariwise, effectiveness of extended thymectomy is still under discussion in patients with generalized MG and atrophic thymus or histological NT because the results of different studies are controversial, and stable remission rates up to 10 years of follow-up are significantly higher in TLH compared to NT or atrophic thymus in the majority of studies.…”

mentioning

confidence: 99%

“…16 Contrariwise, effectiveness of extended thymectomy is still under discussion in patients with generalized MG and atrophic thymus or histological NT because the results of different studies are controversial, and stable remission rates up to 10 years of follow-up are significantly higher in TLH compared to NT or atrophic thymus in the majority of studies. 3,4 To date, no study characterized the NT with DW imaging nor evaluated the ability of DW-MRI in differentiating TLH from NT. In the present study, the mean ADC of TLH was significantly lower than that of NT, although overlapped values were found.…”

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confidence: 99%

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Diffusion-weighted magnetic resonance imaging of thymoma: ability of the Apparent Diffusion Coefficient in predicting the World Health Organization (WHO) classification and the Masaoka-Koga staging system and its prognostic significance on disease-free survival

Priola

Giraudo³

et al. 2015

Eur Radiol

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Objectives: To evaluate the usefulness of diffusion-weighted magnetic resonance for distinguishing thymomas according to WHO and Masaoka-Koga classifications and in predicting disease-free survival (DFS) by using the apparent diffusion coefficient (ADC). Methods:Forty-one patients were grouped based on WHO (low-risk vs. high-risk) and MasaokaKoga (early vs. advanced) classifications. For prognosis, seven patients with recurrence at followup were grouped separately from healthy subjects. Differences on ADC levels between groups were tested using Student-t testing. Logistic regression models and areas under the ROC curve (AUROC) were estimated. Results:Mean ADC values were different between groups of WHO (low-risk=1.58±0.20×10-3mm2/sec; high-risk=1.21±0.23×10-3mm2/sec; p<0.0001) and Masaoka-Koga (early=1.43±0.26×10-3mm2/sec; advanced=1.31±0.31×10-3mm2/sec; p=0.016) classifications.Mean ADC of type-B3 (1.05±0.17×10-3mm2/sec) was lower than type-B2 (1.32±0.20×10-3mm2/sec; p=0.023). AUROC in discriminating groups was 0.864 for WHO classification (cutpoint=1.309×10-3mm2/sec; accuracy=78.1 %) and 0.730 for Masaoka-Koga classification (cut-point=1.243×10-3mm2/sec; accuracy=73.2 %). Logistic regression models and two-way ANOVA were significant for WHOclassification (odds ratio[OR]=0.93, p=0.007; p<0.001), but not for Masaoka-Koga classification (OR=0.98, p=0.31; p=0.38). ADC levels were significantly associated with DFS recurrence rate being higher for patients with ADC≤1.299× 10-3mm2/sec (p=0.001; AUROC, 0.834; accuracy=78.0 %).Conclusions: ADC helps to differentiate high-risk from lowrisk thymomas and discriminates the more aggressive type-B3. Primary tumour ADC is a prognostic indicator of recurrence. Key Points• DW-MRI is useful in characterizing thymomas and in predicting disease-free survival.• ADC can differentiate low-risk from high-risk thymomas based on different histological composition • The cutoff-ADC-value of 1.309×10-3mm2/sec is proposed as optimal cut-point for this differentiation • The ADC ability in predicting Masaoka-Koga stage is uncertain and needs further validations• ADC has prognostic value on disease-free survival and helps in stratification of risk

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Diffusion-weighted magnetic resonance imaging of thymoma: ability of the Apparent Diffusion Coefficient in predicting the World Health Organization (WHO) classification and the Masaoka-Koga staging system and its prognostic significance on disease-free survival

Priola

Giraudo³

et al. 2015

Eur Radiol

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“…Findings from non-randomized studies showed that thymectomy has contributed to MG remission and recovery [14,21], although before the MGTX study, usefulness of thymectomy was found to be controversial in the treatment of AChR antibody-associated MG in absence of thymoma.…”

Section: Efficiency Of Thymectomymentioning

confidence: 99%

Thymectomy in Myasthenia Gravis

Aydın¹,

Ulaş²,

Mutlu³

et al. 2017

Eurasian J Med

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In recent years, thymectomy has become a widespread procedure in the treatment of myasthenia gravis (MG). Likelihood of remission was highest in preoperative mild disease classification (Osserman classification 1, 2A). In absence of thymoma or hyperplasia, there was no relationship between age and gender in remission with thymectomy. In MG treatment, randomized trials that compare conservative treatment with thymectomy have started, recently. As with non-randomized trials, remission with thymectomy in MG treatment was better than conservative treatment with only medication. There are four major methods for the surgical approach: transcervical, minimally invasive, transsternal, and combined transcervical transsternal thymectomy. Transsternal approach with thymectomy is the accepted standard surgical approach for many years. In recent years, the incidence of thymectomy has been increasing with minimally invasive techniques using thoracoscopic and robotic methods. There are not any randomized, controlled studies which are comparing surgical techniques. However, when comparing non-randomized trials, it is seen that minimally invasive thymectomy approaches give similar results to more aggressive approaches.Keywords: Extended thymectomy, follow-up, myasthenia gravis, thoracoscopic thymectomy ÖZ Miyastenia gravis tedavisinde son yıllarda timektomi giderek yaygınlaşan bir prosedür haline geldi. Preoperatif hafif hastalık sınıflaması (Osserman sınıflaması 1, 2A) olanlarda remisyon ihtimali en yüksek olarak gösterildi. Timoma veya hiperplazi yokluğunda timektomi ile remisyon sağlamada yaş ve cinsiyetin ilişkisi gösterilemedi. Miyastenia gravis tedavisinde timektomi ile konservatif tedaviyi karşılatıran randomize çalışmalar yeni yayınlanmaya başlandı. Nonrandomize çalışmalarda olduğu gibi Miyastenia gravis tedavisinde timektomi ile remisyon, sadece ilaçla konservatif tedaviden daha iyi bulundu. Cerrahi yaklaşım için transservikal, minimal invaziv, transsternal ve kombine transservikal transsternal timektomi olmak üzere dört major yöntem bulunmaktadır. Transsternal yaklaşımla timektomi yıllardır kabul gören standart cerrahi yaklaşımdır. Son yıllarda torakoskopik ve robotik yöntemin kullanıldığı minimal invaziv tekniklerle timektomi sıklığı artmaktadır. Cerrahi teknikleri karşılaştıran randomize, kontrollü çalışmalar bulunmamaktadır. Ancak nonrandimize çalışmalar arasındaki karşılaştırmalara bakıldığında minimal invaziv timektomi yaklaşımlarının daha agresif yaklaşımlara benzer sonuçlar verdiği görülmektedir.

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Should Every “Myasthenic Thymectomy” Be Sent to ICU?

Sungur

Şentürk

2017

Postoperative Care in Thoracic Surgery

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Is thymectomy in non-thymomatous myasthenia gravis of any benefit?

Cited by 51 publications

References 17 publications

Diffusion-weighted magnetic resonance imaging of thymoma: ability of the Apparent Diffusion Coefficient in predicting the World Health Organization (WHO) classification and the Masaoka-Koga staging system and its prognostic significance on disease-free survival

Diffusion-weighted magnetic resonance imaging of thymoma: ability of the Apparent Diffusion Coefficient in predicting the World Health Organization (WHO) classification and the Masaoka-Koga staging system and its prognostic significance on disease-free survival

Thymectomy in Myasthenia Gravis

Should Every “Myasthenic Thymectomy” Be Sent to ICU?

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