title: CT cross-sectional imaging classification system for substernal goiter based on risk factors for an extracervical surgical approach.
abstract: BACKGROUND
  The purpose of this study was to identify risk factors for surgical extracervical approach in patients with substernal goiter. We used a novel classification system based on CT scan cross-sectional imaging (CSI) reconstruction.
  
  
  METHODS
  Medical records of 4297 patients with thyroid disease operated on at our department were reviewed. 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); in the anteroposterior dimension as type A (prevascular), type B (retrovascular-paratracheal), and type C (retrotracheal); in the latero-lateral dimension as: monolateral or bilateral.
  
  
  RESULTS
  The prevalence of substernal goiter was 222 of 4297 cases (5.1%). Fifteen of 222 cases (6.7%) required an extracervical approach due to grade ≥2 and/or type C substernal goiter (14 of 15 cases). Ten of 15 patients had malignancy.
  
  
  CONCLUSIONS
  The CT-CSI classification system allows us to identify risk factors for extracervical surgical approach in substernal goiter. They are grade ≥2, type C substernal goiter, and malignancy.
authors.affiliation: Department of Otolaryngology, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy. mercante.giuseppe@gmail.com
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mercante
authors.forename: Enrico
authors.initials: E
authors.lastname: Gabrielli
authors.forename: Corrado
authors.initials: C
authors.lastname: Pedroni
authors.forename: Debora
authors.initials: D
authors.lastname: Formisano
authors.forename: Laura
authors.initials: L
authors.lastname: Bertolini
authors.forename: Franco
authors.initials: F
authors.lastname: Nicoli
authors.forename: Roberto
authors.initials: R
authors.lastname: Valcavi
authors.forename: Verter
authors.initials: V
authors.lastname: Barbieri
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006045:Goiter, Substernal / Q000145:classification / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009333:Neck / Q000601:surgery; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D013965:Thyroidectomy / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult