1 The Ohio State University College of Medicine, Columbus, Ohio, USA.
2 Department of Pediatric Otolaryngology, Nationwide Children's Hospital, Columbus, Ohio, USA.
Otolaryngol Head Neck Surg. 2019 Jun;160(6):1111-1117. doi: 10.1177/0194599819827845. Epub 2019 Feb 5.
To assess clinical evaluation, ultrasound, and previously published predictive score at preoperatively diagnosing midline neck masses and demographic or clinical associations that aid in differentiation of thyroglossal duct and dermoid cysts.
Retrospective chart review.
Tertiary care children's hospital.
Patients <18 years undergoing primary midline neck mass surgery with histopathologic diagnosis of thyroglossal duct or dermoid cyst who had preoperative ultrasound performed were included.
An electronic medical record query generated 142 patients whose histopathologic diagnosis was thyroglossal duct cysts (TGDCs) or dermoid cysts (DCs). Charts were reviewed for demographic and clinical features. A radiologist blindly reviewed patients' ultrasounds for SIST (septae + irregular walls + solid components = thyroglossal) score components. Each patient received 3 preoperative diagnoses: clinical, ultrasound, and SIST. Statistical analyses were conducted to determine association of demographic, clinical, or radiographic variables with diagnoses. Specificity, sensitivity, and predictive values were evaluated for each candidate diagnosis.
There were 83 TGDCs and 59 DCs. Tenderness, infection history, depth relative to strap muscles, and SIST components were more common among TGDCs. Sensitivity and positive and negative predictive values surpassed 63% for each diagnostic modality. SIST score outperformed other diagnostic modalities with sensitivity, positive predictive value, and negative predictive value of 84%, 91%, and 81%, respectively. Clinical and ultrasound assessments were largely inconclusive for dermoid cysts, but SIST correctly identified 89% of DCs.
SIST score was the most accurate predictor of pediatric midline neck masses. Clinical and radiographic findings may help guide preoperative diagnosis, although further evaluation is required to develop more efficacious diagnostic tools.
评估临床评估、超声以及先前发表的预测评分在术前诊断中线颈部肿块以及有助于分化甲状舌管和皮样囊肿的人口统计学或临床关联方面的作用。
回顾性图表审查。
三级儿童保健医院。
接受原发性中线颈部肿块手术且术前进行超声检查的 18 岁以下患者，其组织病理学诊断为甲状舌管囊肿（TGDC）或皮样囊肿（DC）。
电子病历查询生成了 142 名患者的组织病理学诊断为甲状舌管囊肿（TGDC）或皮样囊肿（DC）。对图表进行了人口统计学和临床特征的审查。一位放射科医生对患者的超声检查进行了 SIST（隔膜+不规则壁+实性成分=甲状舌管）评分检查。每位患者接受了 3 种术前诊断：临床、超声和 SIST。进行了统计学分析以确定人口统计学、临床或影像学变量与诊断的关联。评估了每种候选诊断的特异性、敏感性和预测值。
有 83 个 TGDC 和 59 个 DC。触痛、感染史、相对于颈阔肌的深度和 SIST 成分在 TGDC 中更为常见。每种诊断方法的敏感性、阳性和阴性预测值均超过 63%。SIST 评分的敏感性、阳性预测值和阴性预测值分别为 84%、91%和 81%，优于其他诊断方法。临床和超声评估对皮样囊肿的诊断大多不确定，但 SIST 正确识别了 89%的 DC。
SIST 评分是预测儿童中线颈部肿块的最准确指标。临床和影像学发现可能有助于指导术前诊断，尽管需要进一步评估以开发更有效的诊断工具。
