Making an accurate diagnosis of anterior mediastinal lesions: A proposal for a new diagnostic algorithm from the BTOG Thymic Interest Group

Due to rising demand in cross-sectional thoracic imaging, anterior mediastinal lesions are being identified with increasing frequency. Following iterative and multidisciplinary discussions, the [##########] have developed an algorithm to standardise the diagnostic approach for these relatively uncommon but important conditions which span from benign (thymic remnant, thymic hyperplasia and thymic cysts) to low grade suspected localised malignancy (thymomas) to high grade suspected more aggressive malignancy (thymic carcinoma, lymphoma and germ cell tumours). For each condition we provide a brief description, an overview of the key radiological findings and a description of the proposed algorithm including the rationale behind the recommendations. We also highlight the role of magnetic resonance (MR) imaging for the characterisation of anterior mediastinal masses in specific indications when the necessary local resources and expertise exists. In addition, we hope this provides the rationale for service development in MR of the anterior mediastinum where current resource and expertise requires development. Through this standardised pathway, we hope to drive improvements in patient care by rationalising surveillance schedules, avoiding unnecessary resections of benign entities with their associated morbidity and optimising the diagnostic work-up prior to appropriate treatment of anterior mediastinal malignancies.