Role of high-frequency ultrasound in differentiating benign and malignant skin lesions: potential and limitations
Qiao Wang1,2 , Weiwei Ren1,2 , Lifan Wang3 , Xiaolong Li3 , Anqi Zhu1,2 , Dandan Shan1,2 , Jing Wang4, Yujing Zhao5, Danhua Li6, Tian Tian Ren7, Lehang Guo2 , Huixiong Xu3 , Liping Sun1
1Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, 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
Corresponding Author: Liping Sun ,Tel: +81-21-6630-1296, Fax: +86-21-66307539, Email:
Received: January 30, 2024;  Accepted: May 17, 2024.  Published online: May 17, 2024.
This study examined the diagnostic value of high-frequency ultrasound (HFUS) features in differentiating between benign and malignant skin lesions.
A total of 1,392 patients with 1,422 skin lesions who underwent HFUS examinations were included in an initial dataset (cohort 1) to identify features indicative of malignancy. Qualitative clinical and HFUS characteristics were recorded for all lesions. To determine which HFUS and clinical features were suggestive of malignancy, univariable and multivariable logistic regression analyses were employed. The diagnostic performance of HFUS features combined with clinical information was evaluated. This assessment was validated using internal data (cohort 2) and multicenter external data (cohort 3).
Features significantly associated with malignancy included age above 60 years; lesion location in the head, face, and neck or genital regions; changes in macroscopic appearance; crawling or irregular growth pattern; convex or irregular base; punctate hyperechogenicity; 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 is not suitable for evaluating lesions less than 0.1 mm in thickness or lesions exhibiting surface hyperkeratosis.
In a clinical setting, the integration of HFUS with clinical information exhibited good diagnostic performance in differentiating malignant and benign skin lesions. However, its utility was limited in evaluating extremely thin lesions and those exhibiting hyperkeratosis.
Keywords: Ultrasonography; Skin disease/diagnostic imaging; Dermatology; Imaging
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