Diagnostic value of high‐frequency ultrasound (HFUS) in evaluation of subcutaneous lesions

Abstract

BackgroundIt 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.MethodPatients 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.ResultsThe 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).ConclusionCombining 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.

Integrating vascularity into the pattern classification of pilomatricomas on ultrasound provides a more competent approach for discriminative evaluation

“…While pilomatricomas with typical features evaluated using HFUS and CDFI demonstrate excellent diagnostic performance, misdiagnosis frequently occurs for pilomatricomas with atypical sonographic features. These atypical features can resemble other conditions such as infantile hemangioma, trichilemmal cyst, breast cancer, epidermoid cyst, chronic granuloma, and dermatofibrosarcoma protuberans 4–14 . Accurate diagnosis is crucial for appropriate management 15,16 .…”

“…These atypical features can resemble other conditions such as infantile hemangioma, trichilemmal cyst, breast cancer, epidermoid cyst, chronic granuloma, and dermatofibrosarcoma protuberans. [4][5][6][7][8][9][10][11][12][13][14] Accurate diagnosis is crucial for appropriate management. 15,16 The objective of this study was to investigate the different types of features seen in pilomatricomas on color Doppler sonographies, compare these features with those of epidermoid cysts and dermatofibrosarcoma protuberans, and determine the diagnostic performance of HFUS and CDFI for pilomatricomas.…”