BACKGROUND: Noninvasive techniques to assess subclinical spread of nonmelanoma skin cancer (NMSC) may improve surgical precision. High-resolution ultrasound has shown promise in evaluating the extent of NMSC. OBJECTIVES: To determine the accuracy of high-resolution ultrasound to assess the margins of basal cell (BCC) and squamous cell carcinomas (SCC) before Mohs micrographic surgery (MMS). METHODS: We enrolled 100 patients with invasive SCC or BCC. Before the first stage of MMS, a Mohs surgeon delineated the intended surgical margin. Subsequently, a trained ultrasound technologist independently evaluated disease extent using the EPISCAN I-200 to evaluate tumor extent beyond this margin. The accuracy of high-resolution ultrasound was subsequently tested by comparison with pathology from frozen sections. RESULTS: The test characteristics of the high-resolution ultrasound were sensitivity=32%, specificity=88%, positive predictive value=47%, and negative predictive value=79%. Subgroup analyses demonstrated better test characteristics for tumors larger than the median (area>1.74 cm(2)). Qualitative analyses showed that high-resolution ultrasound was less likely to identify extension from tumors with subtle areas of extension, such as small foci of dermal invasion from infiltrative SCC and micronodular BCC. CONCLUSION: High-resolution ultrasound requires additional refinements to improve the preoperative determination of tumor extent before surgical treatment of NMSC.
BACKGROUND: Noninvasive techniques to assess subclinical spread of nonmelanoma skin cancer (NMSC) may improve surgical precision. High-resolution ultrasound has shown promise in evaluating the extent of NMSC. OBJECTIVES: To determine the accuracy of high-resolution ultrasound to assess the margins of basal cell (BCC) and squamous cell carcinomas (SCC) before Mohs micrographic surgery (MMS). METHODS: We enrolled 100 patients with invasive SCC or BCC. Before the first stage of MMS, a Mohs surgeon delineated the intended surgical margin. Subsequently, a trained ultrasound technologist independently evaluated disease extent using the EPISCAN I-200 to evaluate tumor extent beyond this margin. The accuracy of high-resolution ultrasound was subsequently tested by comparison with pathology from frozen sections. RESULTS: The test characteristics of the high-resolution ultrasound were sensitivity=32%, specificity=88%, positive predictive value=47%, and negative predictive value=79%. Subgroup analyses demonstrated better test characteristics for tumors larger than the median (area>1.74 cm(2)). Qualitative analyses showed that high-resolution ultrasound was less likely to identify extension from tumors with subtle areas of extension, such as small foci of dermal invasion from infiltrative SCC and micronodular BCC. CONCLUSION: High-resolution ultrasound requires additional refinements to improve the preoperative determination of tumor extent before surgical treatment of NMSC.
Authors: G John Chen; Christopher B Yelverton; Sudhir S Polisetty; Tamara S Housman; Phillip M Williford; Hoa V Teuschler; Steven R Feldman Journal: Dermatol Surg Date: 2006-10 Impact factor: 3.398
Authors: A K Gupta; D H Turnbull; F S Foster; K A Harasiewicz; D T Shum; R Prussick; G N Watteel; L N Hurst; D N Sauder Journal: Dermatol Surg Date: 1996-02 Impact factor: 3.398
Authors: A J Coleman; G P Penney; T J Richardson; A Guyot; M J Choi; N Sheth; E Craythorne; A Robson; R Mallipeddi Journal: Comput Aided Surg Date: 2014-05-01
Authors: Rosa Ballester-Sánchez; Olga Pons-Llanas; Margarita Llavador-Ros; Rafael Botella-Estrada; Antonio Ballester-Cuñat; Alejandro Tormo-Micó; Francisco Javier Celadá-Álvarez; Silvia Rodríguez-Villalba; Manuel Santos-Ortega; Facundo Ballester-Pallarés; Jose Perez-Calatayud Journal: J Contemp Brachytherapy Date: 2014-12-31