Ultrasonography.  2023 Jan;42(1):111-120. 10.14366/usg.22082.

Orientation of the ultrasound probe to identify the taller-than-wide sign of thyroid malignancy: a registry-based study with the Thyroid Imaging Network of Korea

  • 1Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
  • 2Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, 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, Korea
  • 5Department of Radiology, Korea University 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


Although the taller-than-wide (TTW) sign has been regarded as one of the most specific ultrasound (US) features of thyroid malignancy, uncertainty still exists regarding the US probe’s orientation when evaluating it. This study investigated which US plane would be optimal to identify the TTW sign 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, 1,089 malignant and 4,512 benign) collected in the webbased registry of Thyroid Imaging Network of Korea through the collaboration of 26 centers. The present study assessed the diagnostic performance of the TTW sign itself and fine needle aspiration (FNA) indications via a comparison of four international guidelines, depending on the orientation of the US probe (criterion 1, transverse plane; criterion 2, either transverse or longitudinal plane).
Overall, the TTW sign was more frequent in malignant than in benign thyroid nodules (25.3% vs. 4.6%). However, the 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<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 (all P>0.05, respectively).
A longitudinal US probe orientation provided little additional diagnostic value over the transverse orientation in detecting the TTW sign of thyroid nodules.


Thyroid nodule; Ultrasonography; Needle biopsy; Differential diagnosis
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