Orientation of ultrasound probe to identify the taller-than-wide sign of thyroid malignancy: a registry-based study with the thyroid imaging network of Korea
Min Ji Hong1 , Younghen Lee2 , Ji-hoon Kim3 , Dong Gyu Na4 , Sung-Hye You5 , Ji Eun Shin6 , Seul Kee Kim7 , Kyung-Sook Yang8
1Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
2Korea University, Ansan-si,Gyeonggi-do , Korea
3Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
4Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung-si, Korea
5Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, Korea
6Health Screening and Promotion Center, Asan Medical Center, Seoul, Korea
7Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
8Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
Corresponding Author: Younghen Lee ,Tel: 031-412-5228, Fax: 031-412-5224, Email: younghen@korea.ac.kr
Received: May 16, 2022;  Accepted: July 19, 2022.  Published online: August 2, 2022.
Although taller-than-wide (TTW) has been regarded as one of the most specific ultrasound (US) features of thyroid malignancy, uncertainty still exists for US probe’s orientation to evaluate it. We determined which US plane would be optimal to identify TTW based on malignancy risk stratification using a registry-based imaging dataset.
A previous study by 17 academic radiologists retrospectively analyzed the US images of 5,601 thyroid nodules (≥1 cm, malignant: benign=1089: 4512) collected in the web-based registry of Thyroid Imaging Network of Korea from the multicenter collaboration of 26 centers. We assessed the diagnostic performance of TTW itself and fine needle aspiration (FNA) indications while comparing four international guidelines depending on the orientation of US probe (criterion 1, transverse plane; criterion 2, either transverse or longitudinal plane).
Overall, TTW was more frequent in malignant than in benign thyroid nodules (25.3% vs. 4.6%). However, statistical differences between criteria 1 and 2 were negligible for sensitivity, specificity, and area under the curve (AUC), based on the size effect (all p-values <0.05, Cohen’s d=0.19, 0.10, and 0.07, respectively). Moreover, the sensitivity, specificity, and AUC of the four FNA guidelines were similar between criteria 1 and 2 (p ≥0.125, p ≥0.063, and p ≥0.083, respectively).
Longitudinal ultrasound probe orientation provided little additional diagnostic value in detecting the taller-than-wide sign of thyroid nodules over the transverse orientation
Keywords: Thyroid nodule; ultrasonography; biopsy, needle; diagnosis, Differential
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