The DETECTION project part 1: An international Delphi survey about diagnostics and treatment of anterior mediastinal cystic lesions

BACKGROUND: Differentiating benign anterior mediastinal cysts from malignancies is challenging in clinical practice. International guidelines on optimal diagnostics and treatment for anterior mediastinal cystic lesions are lacking. The first part of the DETECTION project focuses on possible heterogeneity in diagnostics and treatment of anterior mediastinal cystic lesions among international thoracic medical experts. METHODS: A Delphi-survey was created by 14 multidisciplinary panel members, affiliated with three Dutch tertiary referral hospitals for thymic tumours. The survey contained 55 questions and was reviewed by international experts of the International Thymic Malignancy Interest Group (ITMIG) and Réseau tumeurs THYMiques et Cancer (RYTHMIC). The survey was launched online for members of the ITMIG and RYTHMIC from May 26th, 2023 till July 18th, 2023. RESULTS: The survey was completed by 21 thoracic surgeons, 15 radiologists, 15 medical oncologists, 11 pathologists, 9 pulmonologists, and 4 radiation oncologists from 24 countries. Heterogeneity was observed in performed diagnostic radiological imaging, laboratory tests, indications for surgery and follow-up of anterior mediastinal cysts. Cystic wall thickness of anterior mediastinal cysts was reported as clinical relevant in decision making more frequently by thoracic surgeons (76.2 %) than pulmonologists (44.4 %) and medical oncologists (15.4 %) (p = 0.015). CONCLUSIONS: The survey outcomes showed heterogeneity in the diagnostics and indication for resection of anterior mediastinal cysts among thoracic medical experts. A large variation in radiological imaging, laboratory tests, surgery, pathological analyses, and follow-up of anterior mediastinal cysts was observed. The development of evidence-based clinical practice guidelines may guide clinicians.