A New Metric Classification System for Surgical Management of Retrosternal Goitres.

Abstract

Objective: To introduce a new metric classification system based on preoperative CT scans in the management of retrosternal thyroid pathologies.

Study design: Descriptive study. Place and Duration of the Study: Department of Otolaryngology, Northwest General Hospital and Research Centre, Peshawar, Pakistan, from June 2017 to 2023.

Methodology: Five hundred and eleven thyroidectomy cases were retrospectively reviewed, identifying 68 with retrosternal extension and 41 with preoperative CT scans showing retrosternal goitres (RSG). Using the thoracic inlet plane as a reference, a new metric-based classification system was developed and analysed, categorising RSG into three grades based on CT measurements. Statistical analysis was performed using SPSS version 25, and the association between RSG grades and the need for sternotomy was evaluated using the Chi-square test at 5% significance.

Results: The 41 patients had retrosternal goitres (RSG), which were classified into three categories based on the length from the thoracic inlet on preoperative scans. Grade I represented RSG length of less than 3 cm (15/41) from the thoracic inlet. Grade II ranged from 3-6 cm (22/41), and Grade III exceeded 6 cm (4/41). Grade I RSGs were exclusively managed through a conventional cervical approach, whereas 31.8% of Grade II and 75% of Grade III cases required sternotomy.

Conclusion: This classification offers a simple, metric-based framework that uniquely predicts the likelihood of sternotomy, simplifying preoperative planning and improving surgical outcomes during retrosternal thyroid surgeries.

Key words: Classification, Goitre, Retrosternal, Sternotomy, Thyroidectomy.