Thyroid B-flow twinkling sign: a new feature of papillary cancer.
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.
Brunese
Luca
L
Department of Health Science, Chair of Radiology, University of Molise, Campobasso, Italy.
Romeo
Antonio
A
Iorio
Sergio
S
Napolitano
Giuseppina
G
Fucili
Stefano
S
Zeppa
Pio
P
Vallone
Gianfranco
G
Lombardi
Gaetano
G
Bellastella
Antonio
A
Biondi
Bernadette
B
Sodano
Antonio
A
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*