Clinicopathological Significance of Ultrasound Risk Features and the Taller-Than-Wide Sign for Tumor Advancement in Differentiated Thyroid Cancer: A Single-Center Analysis

Michał Miciak,1 Krzysztof Jurkiewicz,1,2 Natalia Kalka,1 Maja Reiner,1 Maksymilian Cyprian Szymański,1 Szymon Biernat,1 Dorota Diakowska,3 Krzysztof Kaliszewski11Clinical Department of General Surgery, University Centre of General and Oncological Surgery, Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland; 2Doctoral School, Wroclaw Medical University, Wroclaw, Poland; 3Division of Medical Biology, Department of Midwifery, Faculty of Nursing and Midwifery, Wroclaw Medical University, Wroclaw, PolandCorrespondence: Michał Miciak, Clinical Department of General Surgery, University Centre of General and Oncological Surgery, Faculty of Medicine, Wroclaw Medical University, Borowska Street 213, Wroclaw, 50-556, Poland, Email michal.miciak00@gmail.comPurpose: Ultrasound (US) imaging plays a pivotal role in the preoperative assessment of thyroid cancer (TC). Suspicious US features, including hypoechogenicity, microcalcifications, high vascularity, irregular shape, irregular margins, and the taller-than-wide (TTW) sign, are widely used for preoperative risk stratification of thyroid nodules. This study aimed to investigate the associations between preoperative US features and histopathological indicators of tumor advancement in differentiated thyroid cancer (DTC).Patients and Methods: We conducted a retrospective analysis of 665 patients with DTC who were treated between 2008 and 2024. Preoperative US features, including hypoechogenicity, microcalcifications, high vascularity, irregular shape, irregular margins, and the TTW sign, were correlated with extrathyroidal extension (ETE) and lymph node metastases (LNM). Associations were evaluated using Pearson’s χ2 test, Fisher’s exact test where appropriate, odds ratios (ORs), and Cramér’s V. Statistical significance was defined as p < 0.05.Results: All analyzed US features were significantly associated with histopathological indicators of tumor advancement (p < 0.05). Of all evaluated conventional US features, the strongest associations were observed between microcalcifications and ETE, and between high vascularity and LNM (Cramér’s V = 0.32 and 0.38, respectively). The TTW sign was significantly associated with ETE (OR = 2.96, 95% CI: 1.73– 5.07) and LNM (OR = 9.07, 95% CI: 5.07– 16.24).Conclusion: Among US features, the TTW sign demonstrated particularly strong associations with histopathological indicators of tumor advancement, especially LNM. These findings support the potential value of comprehensive preoperative assessment of US features and warrant further prospective studies with multivariable modelling to better define the role of the TTW sign in preoperative risk stratification of DTC.Keywords: differentiated thyroid cancer, ultrasound imaging, taller-than-wide sign, thyroid surgery, extrathyroidal extension, lymph node metastasis