{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T18:54:49Z","timestamp":1784055289191,"version":"3.55.0"},"reference-count":40,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2022,5,1]],"date-time":"2022-05-01T00:00:00Z","timestamp":1651363200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Purpose: (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. Methods: 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. Results: Prospective part: out of 441 consecutively evaluated thyroid nodules, 6 were found to be malignant (1.4%, 95% CI 0.6\u20132.7%). Among the 74 TTW nodules (17%), 1 was malignant (1%, 95% CI 0\u20134%). TTW nodules were more often located in the dorsal half of the thyroid than non-TTW nodules (factor 2.3, p = 0.01, 95% CI 2.1\u20132.5) and more often located in close proximity to a horn than non-TTW nodules (factor 3.0, p = 0.01, 95% CI 2.4\u20133.8). 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\u20132.5) and 2.5 times more often benign when it was associated with a horn (95% CI 1.2\u20135.3). The overall probability of malignancy for TTW nodules was 38% (95% CI 30\u201346%) 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.<\/jats:p>","DOI":"10.3390\/jcm11092549","type":"journal-article","created":{"date-parts":[[2022,5,1]],"date-time":"2022-05-01T06:23:08Z","timestamp":1651386188000},"page":"2549","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Introducing a Pole Concept for Nodule Growth in the Thyroid Gland: Taller-than-Wide Shape, Frequency, Location and Risk of Malignancy of Thyroid Nodules in an Area with Iodine Deficiency"],"prefix":"10.3390","volume":"11","author":[{"given":"Manuela","family":"Petersen","sequence":"first","affiliation":[{"name":"Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Stra\u00dfe 44, 39120 Magdeburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone A.","family":"Schenke","sequence":"additional","affiliation":[{"name":"Department and Institute of Nuclear Medicine, Hospital Bayreuth, 95445 Bayreuth, Germany"},{"name":"Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, 39120 Magdeburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Zimny","sequence":"additional","affiliation":[{"name":"Institute for Nuclear Medicine Hanau, 63450 Hanau, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rainer","family":"G\u00f6rges","sequence":"additional","affiliation":[{"name":"Clinic for Nuclear Medicine, University Hospital Essen, 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8056-7290","authenticated-orcid":false,"given":"Michael","family":"Grunert","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, German Armed Forces Hospital Ulm, 89081 Ulm, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7927-6226","authenticated-orcid":false,"given":"Daniel","family":"Groener","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, University Hospital Frankfurt, 60590 Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3447-4971","authenticated-orcid":false,"given":"Philipp","family":"Seifert","sequence":"additional","affiliation":[{"name":"Clinic of Nuclear Medicine, University Hospital Jena, 07749 Jena, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter E.","family":"St\u00f6mmer","sequence":"additional","affiliation":[{"name":"Institute for Pathology, Pathologicum, 86150 Augsburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5905-6015","authenticated-orcid":false,"given":"Michael C.","family":"Kreissl","sequence":"additional","affiliation":[{"name":"Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, 39120 Magdeburg, Germany"},{"name":"Research Campus STIMULATE, Otto-von-Guericke University, 39106 Magdeburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander R.","family":"Stahl","sequence":"additional","affiliation":[{"name":"Institute for Radiology and Nuclear Medicine, RIZ, 86150 Augsburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the German TIRADS Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,5,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1016\/j.beem.2014.01.001","article-title":"Epidemiology of nodular goitre. 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