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. DESIGN: Cross-sectional cohort study from September 2006 to April 2008. SETTING: Department of Radiology and Endocrinology, University of Naples Federico II, and Department of Endocrinology, Second University of Naples. PATIENTS: A total of 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, 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 ≥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.