High rate of unnecessary thymectomy and its cause. Can computed tomography distinguish thymoma, lymphoma, thymic hyperplasia, and thymic cysts?

Ackman, Jeanne B.; Verzosa, Stacey; Kovach, Alexandra E.; Louissaint, Abner; Lanuti, Michael; Wright, Cameron D.; Shepard, Jo-Anne O.; Halpern, Elkan F.

doi:10.1016/j.ejrad.2014.11.042

Cited by 125 publications

(100 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Focal necrosis existed in 33.3% of thymomas in our results, consistent with the results of other studies, where focal necrosis was found in 28–42% of thymomas. In accordance with previous studies, thymic bed cysts tended to have a smooth contour and median location, while thymomas tended to be located off‐midline.…”

Section: Discussionsupporting

confidence: 91%

See 1 more Smart Citation

Age‐ and gender‐specific disease distribution and the diagnostic accuracy of CT for resected anterior mediastinal lesions

et al. 2019

View full text Add to dashboard Cite

Background Anterior mediastinal lesions account for approximately half of all mediastinal masses and computed tomography (CT) is known to exhibit limited differentiating performance. Our aim was to evaluate the age‐ and gender‐specific distribution of anterior mediastinal lesions and the diagnostic accuracy of multi‐detector CT (MDCT). Methods This retrospective study included 549 consecutive patients with proven anterior mediastinal lesions and diagnostic MDCT scans. The age‐ and gender‐specific distribution of proven diagnoses and diagnostic accuracy were reviewed. The CT features of malignant and benign diseases having the lowest accuracy were compared with those of the most commonly misdiagnosed diseases. Results The proportion of malignancy showed a V‐shape relationship with age (lowest, 52.7% [50s]). The most prevalent malignancies were lymphoma (20s), lymphoma/thymoma (30s), thymoma (40s–50s), and thymoma/thymic carcinoma (≥60s). The most prevalent benign diseases were thymic remnant/hyperplasia (20s–30s), and thymic bed cyst (≥40s). The first‐choice diagnostic accuracy of MDCT decreased with age regardless of gender: 75.4% (20s), 75.0% (30s), 67.8% (40s), 58.5% (50s), and 53.4% (≥60s), primarily due to incorrect diagnoses of thymic bed cyst and thymic carcinoma (accuracy, 42.3% and 30.5%), which were prevalent in older patients and mostly misdiagnosed as thymoma. The most powerful differentiating MDCT features were water attenuation (≤20 HU) (OR, 42.7 [95%CI, 8.8–‐208.3], P < 0.001) for thymic bed cyst and mediastinal lymphadenopathy (6.8 [1.7–27.2], P = 0.006) for thymic carcinoma, but both showed low sensitivity (34.5% and 18.6%, respectively). Conclusions MDCT accuracy depended on age, owing to the age‐specific distribution of thymic carcinoma and thymic bed cyst, which frequently lacks distinguishable CT features from thymoma.

show abstract

Section: Discussionsupporting

confidence: 91%

“…The previous study reported that single‐channel chest CT offers modest diagnostic accuracy, with a correct first‐choice diagnosis of 61% (95% CI, 52–69%; 78/126) . As a result, some anterior mediastinal pathologies still receive incorrect imaging diagnoses, leading to nontherapeutic thymectomy in 22% to 44% of cases …”

Section: Introductionmentioning

confidence: 99%

Age‐ and gender‐specific disease distribution and the diagnostic accuracy of CT for resected anterior mediastinal lesions

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Univariate analysis showed that a diameter ≤3 cm, a CT value >20 Hu, a negative X-ray, and a location in the midline reduced the diagnostic sensitivity of CT. The multivariate logistic regression showed that a diameter ≤3 cm and an unenhanced CT value >20 Hu were independent factors indicative of an incorrect preoperative diagnosis from the chest CT. Ackman et al (12) reported that the CT values of thymic cysts ranged from −19.9 to 58.2 Hu, and a CT value >20 Hu was found in 62.5% (5/8) patients, which is similar to our results. It is difficult to discern cystic lesions from solid masses simply by the CT value in some thymic cyst patients.…”

Section: Discussionsupporting

confidence: 83%

Clinical features, diagnosis and thoracoscopic surgical treatment of thymic cysts

Wang

Xiao

et al. 2017

J. Thorac. Dis.

View full text Add to dashboard Cite

Background: Thymic cysts are rare benign developmental anomalies and there is no consensus management for thymic cysts. The aim of this study was to disclose the efficacy of perioperative diagnosis for thymic cysts by chest computerized tomography (CT) and to elucidate the surgical procedure by videoassisted thoracic surgery (VATS) in the management of thymic cysts. Conclusions: A diameter ≤3 cm and an unenhanced CT value >20 Hu were independent factors of incorrect diagnosis of chest CT. VATS is a reliable approach for the surgical resection of thymic cysts. We think that local resection is adequate for simple thymic cysts. However, thymectomy is necessary when there is suspicion of a thymoma or multilocular thymic cyst, and radical thymectomy is advisable for patients with autoimmune diseases.

show abstract

“…On CT, thymomas are homogenous soft-tissue masses with sharp borders and a lobulated, round, or oval shape (13). Although, bipyramidal shape and presence of intercalated fat were pathognomonic for thymic hyperplasia, not all of them exhibit these features on CT. Ackman et al (4) showed that intercalated fat was not observed on CT in half of the thymic hyperplasia cases. Therefore, chemical shift MRI may provide diagnostic clues to differentiate between thymic hyperplasia and thymoma, based on the signal loss on opposed-phase images in thymic hyperplasia suggestive of microscopic fat (13).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of anterior mediastinal solid tumors by CT perfusion: a preliminary study

Bakan

Kandemirli²,

Dikici³

et al. 2017

Diagn Interv Radiol

View full text Add to dashboard Cite

High rate of unnecessary thymectomy and its cause. Can computed tomography distinguish thymoma, lymphoma, thymic hyperplasia, and thymic cysts?

Cited by 125 publications

References 29 publications

Age‐ and gender‐specific disease distribution and the diagnostic accuracy of CT for resected anterior mediastinal lesions

Age‐ and gender‐specific disease distribution and the diagnostic accuracy of CT for resected anterior mediastinal lesions

Clinical features, diagnosis and thoracoscopic surgical treatment of thymic cysts

Evaluation of anterior mediastinal solid tumors by CT perfusion: a preliminary study

Contact Info

Product

Resources

About