Department of Medical Ultrasound, Shanghai Tenth People's Hospital; Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, School of Medicine, Tongji University, Shanghai, China.
Department of Medical Ultrasound, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China.
Skin Res Technol. 2023 Sep;29(9):e13464. doi: 10.1111/srt.13464.
It is unknown whether high-frequency ultrasound (HFUS) can evaluate invisible subcutaneous lesions. We aimed to investigate the diagnostic value of HFUS in invisible subcutaneous lesions.
Patients with invisible subcutaneous lesions were prospectively recruited from two centres. Before undergoing biopsy or surgery, each lesion was independently evaluated by two clinicians. One provides a clinical diagnosis by only clinical examination and the other provides an integrated diagnosis by combining clinical examination and HFUS information. Diagnoses were classified as correct, wrong, and indeterminate. A total of 391 lesions from 355 patients were enrolled, including 225 epidermoid cysts, 77 lipomas, 25 pilomatrixomas, 21 haemangiomas, 19 dermatofibromas, 11 dermatofibrosarcoma protuberans (DFSP), 7 neurofibromas, and 6 leiomyomas. Using pathological results as the gold standard, diagnostic performance was compared.
The number of correct diagnoses increased from 185 (47.3%) by clinical examination alone to 316 (80.8%) after the addition of HFUS (P < 0.05). Meanwhile, the indeterminate diagnosis rate decreased from 143 (36.6%) to 10 (2.6%). Using HFUS, the accuracy improved significantly for epidermoid cysts (59.6% vs. 86.7%), lipomas (50.6% vs. 94.8%), pilomatrixomas (0% vs. 48.0%), haemangiomas (23.8% vs. 57.1%), and DFSPs (0% vs. 81.8%) (all p < 0.05). However, HFUS did not significantly improve the diagnostic accuracy of dermatofibromas (15.8% vs. 21.1%, p > 0.999), neurofibromas (42.9% vs. 71.4%, p = 0.625), or leiomyomas (16.7% vs. 100%, p = 0.063).
Combining HFUS and clinical examination can generally improve the diagnostic accuracy and decrease the indeterminacy of invisible subcutaneous lesions, especially epidermoid cysts, lipomas, pilomatrixomas, haemangiomas, and DFSPs. However, for some rare lesions, HFUS cannot provide useful information.
目前尚不清楚高频超声（HFUS）是否可用于评估看不见的皮下病变。本研究旨在探讨 HFUS 对看不见的皮下病变的诊断价值。
前瞻性招募来自两个中心的看不见的皮下病变患者。在进行活检或手术之前，由两位临床医生分别独立评估每个病变。一位仅通过临床检查提供临床诊断，另一位通过结合临床检查和 HFUS 信息提供综合诊断。诊断分为正确、错误和不确定。共纳入 355 例患者的 391 个病变，包括 225 个表皮样囊肿、77 个脂肪瘤、25 个毛母细胞瘤、21 个血管瘤、19 个皮肤纤维瘤、11 个隆突性皮肤纤维肉瘤（DFSP）、7 个神经纤维瘤和 6 个平滑肌瘤。以病理结果为金标准，比较诊断性能。
仅通过临床检查的正确诊断数量从 185 例（47.3%）增加到 HFUS 联合使用后的 316 例（80.8%）（P<0.05）。同时，不确定诊断率从 143 例（36.6%）降至 10 例（2.6%）。使用 HFUS 可显著提高表皮样囊肿（59.6% vs. 86.7%）、脂肪瘤（50.6% vs. 94.8%）、毛母细胞瘤（0% vs. 48.0%）、血管瘤（23.8% vs. 57.1%）和 DFSP（0% vs. 81.8%）的诊断准确性（均 P<0.05）。然而，HFUS并未显著提高皮肤纤维瘤（15.8% vs. 21.1%，P>0.999）、神经纤维瘤（42.9% vs. 71.4%，P=0.625）或平滑肌瘤（16.7% vs. 100%，P=0.063）的诊断准确性。
HFUS 联合临床检查通常可以提高看不见的皮下病变的诊断准确性，降低不确定性，特别是表皮样囊肿、脂肪瘤、毛母细胞瘤、血管瘤和 DFSP。然而，对于一些罕见病变，HFUS 无法提供有用信息。
