Petersen Manuela, Schenke Simone A, Zimny Michael, Görges Rainer, Grunert Michael, Groener Daniel, Seifert Philipp, Stömmer Peter E, Kreissl Michael C, Stahl Alexander R
Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany.
Department and Institute of Nuclear Medicine, Hospital Bayreuth, 95445 Bayreuth, Germany.
J Clin Med. 2022 May 1;11(9):2549. doi: 10.3390/jcm11092549.
: (i) To examine the criterion taller-than-wide (TTW) for the sonographic assessment of thyroid nodules in areas of iodine deficiency in terms of frequency, anatomical distribution within the thyroid gland and risk of malignancy. (ii) To develop a model for nodule growth in the thyroid gland. German multicenter study consisting of two parts. In the prospective part, thyroid nodules were sonographically measured in all three dimensions, location within the thyroid gland and contact to a protrusion-like formation (horn) in the dorsal position of thyroid gland was noted. In addition, further sonographic features such as the composition, echogenity, margins and calcifications were investigated. All nodules from the prospective part were assessed for malignancy as part of clinical routine at the decision of the treating physician adhering to institutionally based algorithms. In the retrospective part, only nodules with fine needle aspiration and/or histology were included. The risk of malignancy in TTW nodules was determined by correlating them with cyotological and histological results. Prospective part: out of 441 consecutively evaluated thyroid nodules, 6 were found to be malignant (1.4%, 95% CI 0.6-2.7%). Among the 74 TTW nodules (17%), 1 was malignant (1%, 95% CI 0-4%). TTW nodules were more often located in the dorsal half of the thyroid than non-TTW nodules (factor 2.3, = 0.01, 95% CI 2.1-2.5) and more often located in close proximity to a horn than non-TTW nodules (factor 3.0, = 0.01, 95% CI 2.4-3.8). Retrospective part: out of 1315 histologically and/or cytologically confirmed thyroid nodules, 163 TTW nodules were retrieved and retrospectively analyzed. A TTW nodule was 1.7 times more often benign when it was dorsal (95% CI 1.1-2.5) and 2.5 times more often benign when it was associated with a horn (95% CI 1.2-5.3). The overall probability of malignancy for TTW nodules was 38% (95% CI 30-46%) in this highly preselected patient group. Conclusion: TTW nodules are common in iodine deficient areas. They are often located in the dorsal half of the thyroid gland and are frequently associated with a dorsal protrusion-like formation (horn) of the thyroid. Obviously, the shape of benign nodules follows distinct anatomical preconditions within the thyroid gland. The frequency of TTW nodules and their predominant benignity can be explained by a pole concept of goiter growth. The difference between the low malignancy risk of TTW nodules found on a prospective basis and the high risk found retrospectively may be the result of a positive preselection in the latter.
（i）从出现频率、在甲状腺内的解剖分布以及恶性风险方面，研究甲状腺结节超声评估中长宽比（TTW）标准在碘缺乏地区的情况。（ii）建立甲状腺结节生长模型。德国多中心研究，分为两个部分。在前瞻性部分，对甲状腺结节进行三维超声测量，记录其在甲状腺内的位置以及与甲状腺背侧突出样结构（角）的接触情况。此外，还研究了其他超声特征，如成分、回声性、边界和钙化情况。前瞻性部分的所有结节由治疗医生根据机构算法决定，作为临床常规的一部分进行恶性评估。在回顾性部分，仅纳入经细针穿刺抽吸和/或组织学检查的结节。通过将TTW结节与细胞学和组织学结果相关联，确定其恶性风险。前瞻性部分：在连续评估的441个甲状腺结节中，发现6个为恶性（1.4%，95%可信区间0.6 - 2.7%）。在74个TTW结节（17%）中，1个为恶性（1%，95%可信区间0 - 4%）。与非TTW结节相比，TTW结节更常位于甲状腺的背侧半部分（系数2.3，P = 0.01，95%可信区间2.1 - 2.5），且比非TTW结节更常靠近角（系数3.0，P = 0.01，95%可信区间2.4 - 3.8）。回顾性部分：在1315个经组织学和/或细胞学确诊的甲状腺结节中，检索出163个TTW结节并进行回顾性分析。当TTW结节位于背侧时，其为良性的可能性高1.7倍（95%可信区间1.1 - 2.5），当与角相关时，其为良性的可能性高2.5倍（95%可信区间1.2 - 5.3）。在这个高度预选的患者组中，TTW结节的总体恶性概率为38%（95%可信区间30 - 46%）。结论：TTW结节在碘缺乏地区很常见。它们常位于甲状腺的背侧半部分，且常与甲状腺背侧突出样结构（角）相关。显然，良性结节的形状遵循甲状腺内明显的解剖学前提条件。TTW结节的出现频率及其主要的良性特征可以用甲状腺肿生长的极概念来解释。前瞻性研究中发现的TTW结节低恶性风险与回顾性研究中发现的高风险之间的差异，可能是后者存在阳性预选的结果。
