Original article
Clinical usefulness of variable-frequency ultrasound in localized lesions of the skin

https://doi.org/10.1016/j.jaad.2009.06.016Get rights and content

Background

High variable-frequency ultrasound is a recently available technique capable of clearly defining skin layers and deeper structures that also provides local perfusion patterns obtained in real time.

Objectives

The aim of the study was to assess the performance of variable-frequency ultrasound in the evaluation of skin lesions.

Methods

We performed a retrospective study of 4338 skin ultrasound examinations in predominantly localized skin lesions, and in a group of 130 healthy controls. We determined ultrasound sensitivity, specificity, and statistical level of certainty, and compared ultrasound diagnoses with clinical diagnoses.

Results

Referring diagnosis was correct in 73% of the lesions, and addition of ultrasound increased correctness to 97% (P < .001 for the difference). Ultrasound overall sensitivity was 99%, specificity was 100%, and statistical diagnostic certainty was 99%

Limitations

Ultrasound in its current version cannot detect lesions that are epidermal only or that measure less than 0.1 mm in depth.

Conclusions

Ultrasound is a reliable adjuvant for the accurate and precise diagnosis of skin lesions.

Section snippets

Methods

This series comprises all consecutive cases medically referred by dermatologists for a color Doppler ultrasound examination at our department of radiology from March 2001 to April 2008. All tests were consistently performed, by the same physician (X. W.), with 15 years of experience in the field of ultrasound. The ultrasound equipment consisted of an HDI 5000 system (Philips Medical Systems, Bothell, WA) with a compact linear probe of variable frequency (7-15 MHz). Frequencies in the upper

Results

High-resolution ultrasound image in normal-appearing skin showed clear separation of the layers with the epidermis being generally seen as a thin hyperechoic line, except in the palmar and plantar areas where it was thicker and bilaminar. The dermis was seen as a hyperechoic band of variable thickness, being predominantly thin in the forearm and thick, as a result of high collagen content, in the lumbar region. The subcutaneous tissue was hypoechoic because of the presence of fat lobules, which

Discussion

In this study we analyzed the results of a large number of skin ultrasound examinations performed at the request of dermatologists for use in their clinical practice. Indeed, the origin spectrum and distribution of the lesions studied appear to correspond to their expected frequency in clinical practice. As would be expected, our study includes mostly entities that primarily represented diagnostic challenges and those lesions requiring follow-up posttherapy.

The current technique, high

Conclusion

As described, noninvasive ultrasound imaging of skin lesions provides clinical information that is highly relevant. Although the accuracy of clinical diagnosis per se is enhanced, ultrasound also improves diagnostic precision. This is true for all pathologic categories because ultrasound will actually “sculpt out” the lesions from surrounding tissues, making prominent all morphologic details.36, 37 As regards its value in therapy, preoperative ultrasound provides descriptions of lesion

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    Funding sources: None.

    Conflicts of interest: None declared.

    Reprints not available from the authors.

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