Diagnostic value of conventional chest radiography in intrathoracic goiters—retrospective analysis of 2570 patients

Purpose: Since intrathoracic goiters( IG), either cervico- mediastinal goiters(CMGs) or mediastinalnodules (MNs), can lead to sternotomiesand/or evitable reoperations, their detection is mandatory before thyroid surgery. A systematic screening by CT scan or MRI is not conceivable because of their expensiveness. We tested if conventional chest radiography (CCR) could remain a good screening tool for IGbefore thyroid surgery. Methods: In this retrospective study (2554 patients), CCR usefulness was evaluated in relation with patients’ complaints, clinical examination, neck US, and anatomical and surgical findings. Results: CMGs (n = 67) and MNs (n = 42) were symptomatic in 10 and 5 patients, respectively. Clinical examination or neck US suspected their existence in 25 and 13 and 45 and 17 patients, respectively. Among the 50 IGdetected by CCR (42 CMGs and 8 MNs), 4 CMGs and 2 MNs were missed by clinical examination or neck US. CCR failed to detect IGin 59 patients (54%): 25 CMGs (37%) and 34 MNs (80%). Twenty-eight IG(9 CMGs and 19 MNs) were discovered during surgery. CCR resulted in false positive in 88 out of 2445 patients (3.5%). CCR potentially avoided reoperation in two patients (a maximum saving of 6160 €, whereas the total cost of CCR was 54,895 €). Conclusions: CCR should not be used routinely for the preoperative detection of IG. Surgeons should preferably use clinical examination or neck US and directly perform CT scan when a mediastinalextension is suspected.