title: Thyroid B-flow twinkling sign: a new feature of papillary cancer.
abstract: BACKGROUND
  Microcalcifications (aggregated with psammoma bodies), detected by ultrasound (US), are the most specific feature of papillary thyroid cancer (PTC). Using B-flow imaging (BFI), we identified a new sign (the twinkling sign; BFI-TS) in 'suspect' PTC nodules, which appeared to be generated by microcalcifications.
  
  
  OBJECTIVE
  To evaluate whether the BFI-TS was predictive of malignancy, we correlated the BFI-TS with the results of fine needle aspiration cytology and histology.
  
  
  METHODS
  Cross-sectional cohort study from September 2006 to April 2008.
  
  
  METHODS
  Department of Radiology and Endocrinology, University of Naples Federico II, and Department of Endocrinology, Second University of Naples.
  
  
  METHODS
  A total of 306 consecutive patients with 539 thyroid nodules >8 mm in diameter.
  
  
  METHODS
  US and BFI examinations were performed with the Logiq 9 system (General Electric Company, Milan, Italy); all patients underwent cytological examination.
  
  
  RESULTS
  Cytology revealed 455 (84.4%) benign nodules and 84 (15.6%) malignant nodules; the latter were confirmed by postsurgical histological examination (76 cases of PTC, 7 follicular carcinoma, and 1 Hürthle cell carcinoma). All suspect nodules, namely, nodules with potential predictors of thyroid malignancy (e.g., microcalcifications and intra-nodal vascularity), were analyzed by cytology or histology (or both). Of 84, 68 (80.9%) of malignant nodules had >or=4 or more BFI-TSs in at least one scan versus only 12 of 455 (2.6%) of benign lesions.
  
  
  CONCLUSIONS
  Our results indicate that the BFI-TS could be a reliable diagnostic technique in the management of suspect thyroid nodules.
authors.affiliation: Department of Health Science, Chair of Radiology, University of Molise, Campobasso, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Brunese
authors.forename: Antonio
authors.initials: A
authors.lastname: Romeo
authors.forename: Sergio
authors.initials: S
authors.lastname: Iorio
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Napolitano
authors.forename: Stefano
authors.initials: S
authors.lastname: Fucili
authors.forename: Pio
authors.initials: P
authors.lastname: Zeppa
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Vallone
authors.forename: Gaetano
authors.initials: G
authors.lastname: Lombardi
authors.forename: Antonio
authors.initials: A
authors.lastname: Bellastella
authors.forename: Bernadette
authors.initials: B
authors.lastname: Biondi
authors.forename: Antonio
authors.initials: A
authors.lastname: Sodano
mesh_terms: D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle; D002291:Carcinoma, Papillary / Q000000981:diagnostic imaging* / Q000473:pathology; D003430:Cross-Sectional Studies; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013961:Thyroid Gland / Q000000981:diagnostic imaging* / Q000473:pathology; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D016606:Thyroid Nodule / Q000000981:diagnostic imaging / Q000473:pathology; D014463:Ultrasonography / Q000379:methods* / Q000592:standards*