1Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Institute of Research and Education, School of Medicine, Shanghai, China 2Department of Medical Ultrasound, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China 3Department of Ultrasound, Zhongshan Hospital, Institute of Ultrasound in Medicine and Engineering, Fudan University, Shanghai, China 4Department of Ultrasound, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China 5Department of Medical Imaging, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China 6Department of Ultrasound, Jinshan Hospital, Fudan University, Shanghai, China 7Department of Medical Ultrasound, Maanshan People’s Hospital, Maanshan, China
Received: January 30, 2024; Accepted: May 17, 2024. Published online: May 17, 2024.
ABSTRACT
Purpose: To investigate the value of high-frequency ultrasound (HFUS) features in differentiating benign and malignant skin lesions.
Methods: 1392 patients with 1422 skin lesions who underwent HFUS examinations were included in cohort 1 to identify suspicious features. Qualitative clinical and HFUS features of all skin lesions were recorded. Univariable and multivariable logistic regression analysis was performed to determine suspicious HFUS and clinical features for malignant skin lesions. The diagnostic performance of HFUS features combined with clinical information was evaluated and validated in cohort 2 of internal data, as well as in cohort 3 of multi-center external data.
Results: The following features were significantly associated with malignancy: age > 60 y, lesions located in the head & face & neck or genital region, changes in macroscopic appearance, crawling or irregular growth pattern, convex or irregular bottom, punctate hyperechogenicity, present blood flow signals, and feeding arteries. The area under the receiver operating characteristic curve, sensitivity, and specificity of HFUS features combined with clinical information were 0.946, 92.5%, and 86.9% in cohort 1; 0.870, 93.1%, and 80.8% in cohort 2 (610 lesions), and 0.864, 86.2%, and 86.6% in cohort 3 (170 lesions), respectively. However, HFUS cannot evaluate lesions less than 0.1 mm in thickness and lesions with hyperkeratosis on the surface.
Conclusions: In a real clinical situation, the combination of HFUS with clinical information exhibits good diagnostic performance in differentiating malignant and benign skin lesions. However, its utility is limited when evaluating extremely thin lesions and those with hyperkeratosis.
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