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      Thyroid B-flow twinkling sign: a new feature of papillary cancer

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          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.

          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.

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          Most cited references14

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          Management of a solitary thyroid nodule.

          E Mazzaferri (1993)
          Article 0 comments Cited 188 times – based on 0 reviews     Review now
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            Prevalence and distribution of carcinoma in patients with solitary and multiple thyroid nodules on sonography.

            Robert Moore, Mary C. Frates, P Doubilet … (2006)
            Controversy remains as to the optimal management of patients with multiple thyroid nodules. The objective of this study was to determine the prevalence, distribution, and sonographic features of thyroid cancer in patients with solitary and multiple thyroid nodules. We describe a retrospective observational cohort study that was carried out from 1995 to 2003. The study was conducted in a tertiary care hospital. Patients with one or more thyroid nodules larger than 10 mm in diameter who had ultrasound-guided fine needle aspiration (FNA) were included in the study. The main outcome measures were prevalence and distribution of thyroid cancer and the predictive value of demographic and sonographic features. A total of 1985 patients underwent FNA of 3483 nodules. The prevalence of thyroid cancer was similar between patients with a solitary nodule (175 of 1181 patients, 14.8%) and patients with multiple nodules (120 of 804, 14.9%) (P = 0.95, chi(2)). A solitary nodule had a higher likelihood of malignancy than a nonsolitary nodule (P < 0.01). In patients with multiple nodules larger than 10 mm, cancer was multifocal in 46%, and 72% of cancers occurred in the largest nodule. Multiple logistic regression analysis of statistically significant features demonstrates that the combination of patient gender (P < 0.02), whether a nodule is solitary vs. one of multiple (P < 0.002), nodule composition (P < 0.01), and presence of calcifications (P < 0.001) can be used to assign risk of cancer to each individual nodule. Risk ranges from a 48% likelihood of malignancy in a solitary solid nodule with punctate calcifications in a man to less than 3% in a noncalcified predominantly cystic nodule in a woman. In a patient with one or more thyroid nodules larger than 10 mm in diameter, the likelihood of thyroid cancer per patient is independent of the number of nodules, whereas the likelihood per nodule decreases as the number of nodules increases. For exclusion of cancer in a thyroid with multiple nodules larger than 10 mm, up to four nodules should be considered for FNA. Sonographic characteristics can be used to prioritize nodules for FNA based on their individual risk of cancer.
            Article 0 comments Cited 133 times – based on 0 reviews     Review now
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              Fine-needle aspiration biopsy of the thyroid: an appraisal.

              Walid H. Gharib, J Goellner (1993)
              To review the literature on the utility of fine-needle aspiration biopsy in the diagnostic management of nodular thyroid disease. Relevant articles published in major English-language medical journals during the last 10 years. Articles were reviewed to assess the results of fine-needle aspiration biopsy and its effect on thyroid management and cost of care. Fine-needle aspiration biopsy of the thyroid gland is safe, inexpensive, minimally invasive, and highly accurate in the diagnosis of nodular thyroid disease. Four cytologic diagnostic categories are used. Rates for these categories, based on data pooled from seven series, were as follows: benign, 69%; suspicious, 10%; malignant, 4%; and nondiagnostic, 17%. Analysis of recent data suggests a false-negative rate of 1% to 11%, a false-positive rate of 1% to 8%, a sensitivity of 65% to 98%, and a specificity of 72% to 100%. Limitations of fine-needle aspiration are related to the skill of the aspirator, the expertise of the cytologist, and the difficulty in distinguishing some benign cellular adenomas from their malignant counterparts. The introduction of fine-needle aspiration has had a substantial effect on the management of patients with thyroid nodules. The percentage of patients undergoing thyroidectomy has decreased by 25%, and the yield of carcinoma in patients who undergo surgery has increased from 15% to at least 30%. Fine-needle aspiration has decreased the cost of care by 25%. Fine-needle aspiration biopsy is safe, accurate, and cost-effective. The procedure has a central role in the management of thyroid nodules and should be used as the initial diagnostic test.
              Article 0 comments Cited 119 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Eur J Endocrinol
                Journal ID (publisher-id): EJE
                Title: European Journal of Endocrinology
                Publisher: BioScientifica (Bristol )
                ISSN (Print): 0804-4643
                ISSN (Electronic): 1479-683X
                Publication date (Print): October 2008
                Volume: 159
                Issue: 4
                Pages: 447-451
                Affiliations
                [1]simpleDepartment of Health Science, Chair of Radiology, University of Molise CampobassoItaly
                [ 1 ]simpleDepartment of Radiology, University of Naples ‘Federico II’ simplePoliclinico Universitario Federico II Via Pansini 5, 80131, NaplesItaly
                [ 2 ]simpleDepartment of Clinical and Experimental Medicine and Surgery ‘F. Magrassi’, A. Lanzara’ simpleSecond University of Naples NaplesItaly
                [ 3 ]simpleDepartment of Anatomic Pathology and Cytopathology simpleUniversity of Naples ‘Federico II’ NaplesItaly
                [ 4 ]simpleDepartments of Molecular and Clinical Endocrinology and Oncology simpleUniversity of Naples ‘Federico II’ NaplesItaly
                Author notes
                (Correspondence should be addressed to A Sodano; Email: ansodano@ 123456unina.it )
                Article
                Publisher ID: EJE070891
                DOI: 10.1530/EJE-07-0891
                PMC ID: 2754342
                PubMed ID: 18644823
                SO-VID: 6983e5a9-4853-4093-a827-1cc732d8a243
                Copyright © © 2008 European Society of Endocrinology
                License:

                This is an Open Access article distributed under the terms of the European Journal of Endocrinology's Re-use Licence which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 7 June 2008
                Date accepted : 19 June 2008
                Categories
                Subject: Clinical Study

                ScienceOpen disciplines: Endocrinology & Diabetes
                Data availability:
                ScienceOpen disciplines: Endocrinology & Diabetes

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