Dual-plane taller-than-wide definition for thyroid nodules: comparative analysis across TIRADS

Objectives

The selection of ultrasound (US) plane for evaluating the taller-than-wide (TTW) shape remains controversial. This study aimed to determine whether the diagnostic value of TTW criteria differs when used alone or in combination with other US features, and to identify the optimal TTW criterion across four major Thyroid Imaging Reporting and Data Systems (TIRADS: Chinese (C)-TIRADS, American College of Radiology (ACR)-TIRADS, European (EU)-TIRADS and Korean (K)-TIRADS).

Materials and methods

Preoperative US images of thyroid nodules were reviewed retrospectively. Four TTW criteria were defined as follows: transverse plane only (T-only), longitudinal plane only (L-only), both planes (Dual-plane), and either one or both planes (Single- or dual-plane). Diagnostic performance was assessed using the area under the receiver operating characteristic curve (AUC) and net reclassification improvement (NRI) for malignancy prediction and fine-needle aspiration (FNA) guidance.

Results

Among 1125 nodules, 558 (49.6%) were benign and 567 (50.4%) were malignant. Using the TTW shape alone, Single- or dual-plane achieved the highest AUC for malignancy (0.813). Within TIRADS, Dual-plane demonstrated the highest AUCs in C-TIRADS (0.884) and EU-TIRADS (0.874) and improved reclassification, whereas in ACR-TIRADS and K-TIRADS, Dual-plane and Single- or dual-plane performed similarly and outperformed the T-only and L-only. For FNA guidance, the Dual-plane also showed improvements in C-TIRADS and ACR-TIRADS.

Conclusion

The optimal TTW US plane differs when applied alone versus when combined with other suspicious US features. Within the TIRADS, assessment of the TTW shape in both transverse and longitudinal planes achieves superior accuracy and contributes to improving malignancy diagnosis and FNA decision-making.

Key Points

Question Which TTW criterion provides the best diagnostic performance for malignancy risk stratification and FNA guidance across the four major TIRADS?

Findings Dual-plane TTW yielded the best performance in C-TIRADS and EU-TIRADS, and improved FNA guidance in C-TIRADS and ACR-TIRADS versus other TTW criteria.

Clinical relevance The stricter criterion not only improves the malignancy diagnosis but also provides better guidance for biopsy, offering valuable evidence for refining future guideline recommendations and standardizing the evaluation of thyroid nodules.

Graphical Abstract

ACR:

American College of Radiology

AUC:

Area under the receiver operating characteristic curve

C-TIRADS:

Chinese Thyroid Imaging Reporting and Data System

Dual-plane:

Presence of taller-than-wide shape in both transverse and longitudinal planes

EU-TIRADS:

European Thyroid Imaging Reporting and Data System

FNA:

Fine-needle aspiration

K-TIRADS:

Korean Thyroid Imaging Reporting and Data System

L-only:

Presence of taller-than-wide shape only in the longitudinal plane

NRI:

Net reclassification improvement

Single- or dual-plane:

Presence of taller-than-wide shape in either single or both planes

TIRADS:

Thyroid Imaging Reporting and Data Systems

T-only:

Presence of taller-than-wide shape only in the transverse plane

TTW:

Taller-than-wide

US:

Ultrasound

All authors contributed to the idea, gathered the information, interpreted the data, and wrote and approved the final version of the manuscript. Qingan Zeng, Lin Liu and Xin Wen are co-corresponding authors.

This study was supported by the National Natural Science Foundation of China (82202168) and the Foundation for High-Level Talents in Higher Education of Qingyuan People's Hospital.

Authors and Affiliations

1. Department of Ultrasound, The Fifth Affiliated Hospital Sun Yat-Sen University, Zhuhai, China

   Yu Zhuang, Jing Zhong, Qixin Wen, Shanshan Ran, Bixue Deng, Jiayi Hong & Xin Wen

2. Department of Ultrasound, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China

   Jiamin Chen

3. Department of Thyroid and Breast Surgery, The Fifth Affiliated Hospital Sun Yat-Sen University, Zhuhai, China

   Qingan Zeng

4. Department of Thyroid and Breast Surgery, The Sixth School of Clinical Medicine, the Affiliated Qingyuan Hospital (Qingyuan People’s Hospital), Guangzhou Medical University, Qingyuan, China

   Lin Liu

Corresponding authors

Correspondence to Qingan Zeng, Lin Liu or Xin Wen.

Guarantor

The scientific guarantor of this publication is Xin Wen (The Fifth Affiliated Hospital Sun Yat-Sen University, Zhuhai, China).

Conflict of interest

The authors of this manuscript declare no relationships with any companies.

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

No overlap in study subjects or cohort.

Methodology

• Retrospective

• Observational

• Performed at one institution

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