title: Mediastinal goiter: a comprehensive study of 60 consecutive cases with special emphasis on identifying predictors of malignancy and sternotomy.
abstract: BACKGROUND
  We describe the clinical characteristics of patients with mediastinal goiter and our principles in surgical management of this pathology; we also identify the predictive factors of malignancy, sternotomy, and posterior mediastinal extension.
  
  
  METHODS
  We conducted a retrospective chart review of 60 patients with mediastinal goiter who underwent surgical intervention.
  
  
  RESULTS
  Major perioperative complications were recurrent laryngeal nerve sacrifice (3.3%) and vagus nerve sacrifice (1.7%). A total of 12.7% of cases were malignant. The presence of dysphonia increased the likelihood of malignancy (P = .02), and malignancy was associated with a significant increase in sternotomy (P = .04) and nerve sacrifice (P < .001) during surgery. A history of thyroidectomy was a predictive factor for extension of the tumor to the posterior mediastinum (P = .02).
  
  
  CONCLUSIONS
  Presenting with dysphonia is a predictor of malignancy that necessitates careful surgical planning because malignancy is associated with an increase in nerve injury and sternotomy during surgery.
authors: Center for Special Minimally Invasive and Robotic Surgery, Stanford University Medical Center, Palo Alto, CA 94304, USA. babakhaj@yahoo.com
authors: Babak
authors: B
authors: Hajhosseini
authors: Vahid
authors: V
authors: Montazeri
authors: Lachin
authors: L
authors: Hajhosseini
authors: Nariman
authors: N
authors: Nezami
authors: Ramin E
authors: RE
authors: Beygui
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D002471:Cell Transformation, Neoplastic / Q000473:pathology; D015331:Cohort Studies; D055154:Dysphonia / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006045:Goiter, Substernal / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D056346:Sternotomy / Q000009:adverse effects / Q000379:methods*; D013964:Thyroid Neoplasms / Q000473:pathology* / Q000503:physiopathology; D013965:Thyroidectomy / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult