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Thyroid B-Flow Twinkling Sign: A New Feature of Papillary Cancer

L Brunese, Department of Health Science, University of Molise, Campobasso, Italy
A Romeo, Department of Radiology, University Federico II, Naples, Italy
S Iorio, Department of Clinical and Experimental Medicine and Surgery F.Magrassi, A.Lanzara, Second University of Naples, Naples, Italy
G Napolitano, Department of Radiology, University Federico II, Naples, Italy
S Fucili, Department of Radiology, University Federico II, Naples, Italy
P Zeppa, Department of Anatomic Pathology and Cytopathology, University Federico II, Naples, Italy
G Vallone, Department of Radiology, University Federico II, Naples, Italy
G Lombardi, Departments of Molecular & Clinical Endocrinology and Oncology, University Federico II, Naples, Italy
A Bellastella, Department of Clinical and Experimental Medicine and Surgery F.Magrassi, A.Lanzara, Second University of Naples, Naples, Italy
B Biondi, Departments of Molecular & Clinical Endocrinology and Oncology, University Federico II, Naples, Italy
A Sodano, Department of Radiology, University Federico II, Naples, Italy

Correspondence: Luca Brunese, Email: lucabrunese{at}libero.it

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. To this aim, we correlated the BFI-TS with the results of fine needle aspiration cytology and histology.

Design: Cross-sectorial Cohort Study, from September 2006 to April 2008.

Setting: Department of Radiology and Endocrinology, University of Naples Federico II, and the Department of Endocrinology, Second University of Naples.

Patients: 306 consecutive patients with 539 thyroid nodules > 8 mm in diameter.

Main Outcome Measure: US and BFI examinations were performed with the Logiq 9 system (General Electric Company); all patients underwent cytological examination.

Results: Cytology revealed 455 (84.4%) benign nodules and 84 (15.6%) malignant nodules; the latter were confirmed by post-surgical histological examination (76 cases of PTC, 7 cases of follicular carcinoma, and one Hurthle cell carcinoma). All suspect nodules, namely, nodules with potential predictors of thyroid malignancy (e.g., microcalcifications and intranodal vascularity), were analyzed by cytology or histology (or both). 68/84 (80.9%) of malignant nodules had =/> 4 BFI-TSs in at least one scan versus only 12/455 (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.