Hernández-Ibáñez C, Blazquez-Sánchez N, Aguilar-Bernier M, Fúnez-Liébana R, Rivas-Ruiz F, de Troya-Martín M
Servicios de Dermatología y Venereología, Hospital Costa del Sol, Marbella, Málaga, España.
Servicios de Dermatología y Venereología, Hospital Costa del Sol, Marbella, Málaga, España.
Actas Dermosifiliogr. 2017 Jan-Feb;108(1):42-51. doi: 10.1016/j.ad.2016.08.002. Epub 2016 Oct 5.
Incisional biopsy may not always provide a correct classification of histologic subtypes of basal cell carcinoma (BCC). High-frequency ultrasound (HFUS) imaging of the skin is useful for the diagnosis and management of this tumor.
The main aim of this study was to compare the diagnostic value of HFUS compared with punch biopsy for the correct classification of histologic subtypes of primary BCC. We also analyzed the influence of tumor size and histologic subtype (single subtype vs. mixed) on the diagnostic yield of HFUS and punch biopsy.
Retrospective observational study of primary BCCs treated by the Dermatology Department of Hospital Costa del Sol in Marbella, Spain, between october 2013 and may 2014. Surgical excision was preceded by HFUS imaging (Dermascan C, 20-MHz linear probe) and a punch biopsy in all cases. We compared the overall diagnostic yield and accuracy (sensitivity, specificity, positive predictive value [PPV], and negative predictive value [NPV]) of HFUS and punch biopsy against the gold standard (excisional biopsy with serial sections) for overall and subgroup results.
We studied 156 cases. The overall diagnostic yield was 73.7% for HFUS (sensitivity, 74.5%; specificity, 73%) and 79.9% for punch biopsy (sensitivity, 76%; specificity, 82%). In the subgroup analyses, HFUS had a PPV of 93.3% for superficial BCC (vs. 92% for punch biopsy). In the analysis by tumor size, HFUS achieved an overall diagnostic yield of 70.4% for tumors measuring 40mm or less and 77.3% for larger tumors; the NPV was 82% in both size groups. Punch biopsy performed better in the diagnosis of small lesions (overall diagnostic yield of 86.4% for lesions ≤40mm vs. 72.6% for lesions >40mm).
HFUS imaging was particularly useful for ruling out infiltrating BCCs, diagnosing simple, superficial BCCs, and correctly classifying BCCs larger than 40mm.
切开活检可能无法始终正确分类基底细胞癌（BCC）的组织学亚型。皮肤高频超声（HFUS）成像对该肿瘤的诊断和管理很有用。
本研究的主要目的是比较HFUS与打孔活检对原发性BCC组织学亚型正确分类的诊断价值。我们还分析了肿瘤大小和组织学亚型（单一亚型与混合亚型）对HFUS和打孔活检诊断率的影响。
对2013年10月至2014年5月间西班牙马贝拉科斯塔德尔索尔医院皮肤科治疗的原发性BCC进行回顾性观察研究。所有病例在手术切除前均进行了HFUS成像（Dermascan C，20MHz线性探头）和打孔活检。我们将HFUS和打孔活检的总体诊断率和准确性（敏感性、特异性、阳性预测值[PPV]和阴性预测值[NPV]）与金标准（连续切片切除活检）进行比较，以得出总体和亚组结果。
我们研究了156例病例。HFUS的总体诊断率为73.7%（敏感性为74.5%；特异性为73%），打孔活检的总体诊断率为79.9%（敏感性为76%；特异性为82%）。在亚组分析中，HFUS对浅表性BCC的PPV为93.3%（打孔活检为92%）。按肿瘤大小分析，对于直径40mm或更小的肿瘤，HFUS的总体诊断率为70.4%，对于更大的肿瘤为77.3%；两个大小组的NPV均为82%。打孔活检在小病变的诊断中表现更好（直径≤40mm病变的总体诊断率为86.4%，直径>40mm病变的总体诊断率为72.6%）。
HFUS成像对于排除浸润性BCC、诊断单纯性、浅表性BCC以及正确分类大于40mm的BCC特别有用。
