“Black Ink” Sonographic Pattern as a Predictor for Invasive Papillary Thyroid Micro Carcinoma: A Case Report
Ersilio Trapanese
Interventional Ultrasound of Breast Oncology Screening - ASL Salerno, Italy.
Basilio Angrisani
Department of Anatomical Pathology, Del Mare Hospital, ASL Naples, Italy.
Alberto Angrisani
Department of Biology, University of Naples “Federico II”, Monte Sant’Angelo University Complex, Italy.
Ermanno D’Arco
Department of Endocrine Surgery, San Francesco d’Assisi Hospital, ASL Salerno, Italy.
Mariano Agrusta
Department of Endocrinology and Diabetology, Cava Amalfi Hospital, ASL Salerno, Italy.
Carmine De Bartolomeis
Department of Endocrine Surgery, Barbantini Private Hospital, Lucca, Italy.
Stefano Laudati
Department of Anatomical Pathology, Del Mare Hospital, ASL Naples, Italy.
Giulio Tarro *
President Foundation T. & L. de Beaumont Bonelli for Cancer Research, Italy and World Academy of Biomedical Technologies (WABT), UNESCO, Paris, France.
*Author to whom correspondence should be addressed.
Abstract
Background: This study investigated the utility of the Sonographic pattern "Black Ink" with BRAF mutation testing of thyroid fine-needle aspiration cytology specimens for the risk papillary thyroid microcarcinoma (PTMC).
Case Presentation: We describe a case of a 41-year-old Caucasian woman affected by a ultrasonography “Black Ink” papillary thyroid microcarcinoma (PTMC) of the left lobe of the thyroid gland with very tiny size (Ø 0.4 cm). The characteristics, with the Diagnostic Imaging using Ultrasonography (US), Superb Micro-Vascular Imaging (SMI), fine-needle-aspiration cytology (FNAC) and mutation analysis are here discussed. There are more rare subtypes of thyroid cancer as papillary microcarcinoma "Black Ink" that even if small, are invasive and there is why the need to early diagnosis to avoid their aggressive behavior is needed. Nowadays, focusing on the size, the cut-off for non-occult tiny tumors has dropped to 0.3 cm. This value is of great relevance.
Conclusion: Ultrasonography, FNAC and BRAF molecular study have proven to be the most sensitive diagnostic combination for the early detection of thyroid cancer. Despite the size of this micro-lesion, the Black Ink ultrasonographic pattern associated with malignant cytology at FNAC represents an important biological risk factor and could still be a predictor of the PTMC and risk for neck lymph node metastases.
Keywords: Ultrasonography, superb micro-vascular imaging, papillary thyroid micro carcinoma, black ink sonographic pattern, BRAFV600E