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Which ultrasound image plane is appropriate for evaluating the taller-than-wide sign in the risk stratification of thyroid nodules?

  • Ultrasound
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Abstract

Objectives

This study aimed to determine the ultrasound (US) image plane appropriate for evaluating the taller-than-wide (TTW) sign in the risk stratification of thyroid nodules using the five widely used risk stratification systems (RSSs).

Methods

A total of 1905 consecutive thyroid nodules with final diagnoses were included. The TTW sign was prospectively assessed in the transverse and longitudinal US image planes. The diagnostic performances of the TTW sign and biopsy criteria by the RSSs for malignancy were compared by sensitivity, specificity, and receiver operating characteristic curve analysis between the two criteria of TTW signs according to image planes (criterion 1, transverse plane; criterion 2, either transverse or longitudinal plane).

Results

Of all 1905 nodules, 1481 (77.7%) were benign and 424 (22.3%) were malignant. The criteria 1 and 2 of TTW signs had similar sensitivities (37.5% and 38.7%) and specificities (94.8% and 94.4%) with minimal differences, and the area under the curve (AUC) of TTW signs for malignancy was not significantly different between criteria 1 and 2 (0.662 and 0.665, p = 0.158, respectively). The sensitivity, specificity, and AUC of biopsy criteria by the five RSSs were not significantly different between criteria 1 and 2 in nodules ≥ 1 cm (p ≥ 0.157, p ≥ 0.317, and p ≥ 0.198, respectively).

Conclusions

The diagnostic performances of the TTW sign and biopsy criteria of the five RSSs were similar between criteria 1 and 2. TTW signs by criterion 1 (transverse plane) may be appropriate in the risk stratification of thyroid nodules.

Key Points

• The diagnostic performance of the taller-than-wide sign by ROC analysis was not significantly different between US image plane criteria (transverse plane vs. either transverse or longitudinal plane).

• The diagnostic performances of biopsy criteria for malignancy by the five risk stratification systems were similar between the two taller-than-wide sign criteria.

• The taller-than-wide sign using the transverse plane may be appropriate in the risk stratification of thyroid nodules.

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Abbreviations

AACE:

American Association of Clinical Endocrinologists

ACE:

American College of Endocrinology

ACR-TIRADS:

American College of Radiology Thyroid Imaging Reporting and Data System

AME:

Associazione Medici Endocrinologi

ATA:

American Thyroid Association

AUC:

Area under the curve

CNB:

Core-needle biopsy

EU-TIRADS:

European Thyroid Imaging Reporting and Data System

FNA:

Fine-needle aspiration

IQR:

Interquartile range

KSThR:

Korean Society of Thyroid Radiology

K-TIRADS:

Korean Thyroid Imaging Reporting and Data System

PPV:

Positive predictive value

PTC:

Papillary thyroid carcinoma

ROC:

Receiver operating characteristic

RSS:

Risk stratification system

TTW:

Taller-than-wide

US:

Ultrasonography

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Funding

This research was supported by the Medical Research Promotion Program through the Gangneung Asan Hospital funded by the Asan Foundation (2020IC001).

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Authors and Affiliations

  1. Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, 38 Bangdong-gil, Sacheon-myeon, Gangneung-si, Gangwon-do, 25440, Republic of Korea

    Suh Young Kim, Dong Gyu Na & Wooyul Paik

Authors
  1. Suh Young Kim
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  2. Dong Gyu Na
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  3. Wooyul Paik
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Corresponding author

Correspondence to Dong Gyu Na.

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Guarantor

The scientific guarantor of this publication is Dong Gyu Na.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects have been previously reported in a study (Sohn YM, Na DG, Paik W, Gwon HY, Noh BJ. Malignancy risk of thyroid nodules with nonshadowing echogenic foci. Ultrasonography 2020;10.14366/usg.20012.)

Methodology

• retrospective

• diagnostic study

• performed at one institution

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Kim, S.Y., Na, D.G. & Paik, W. Which ultrasound image plane is appropriate for evaluating the taller-than-wide sign in the risk stratification of thyroid nodules?. Eur Radiol 31, 7605–7613 (2021). https://doi.org/10.1007/s00330-021-07936-4

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  • DOI: https://doi.org/10.1007/s00330-021-07936-4

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