Bahar Dasgeb1,2, Michael A Morris3,4, Darius Mehregan5,6, Eliot L Siegel3,7. 1. 1 Department of Medicine Dermatology Service, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA. 2. 2 Analytical and Stochastic Biomedical Physics Section, National Institutes of Health, Bethesda, MD, USA. 3. 3 Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, MD, USA. 4. 4 Department of Internal Medicine, Mercy Medical Center, Baltimore, MD, USA. 5. 5 Department of Dermatology, Wayne State University, Dearborn, MI, USA. 6. 6 Pinkus Dermatopathology Laboratories, Monroe, MI, USA. 7. 7 Department of Diagnostic Radiology and Nuclear Medicine, Baltimore Veterans Affairs Medical Center, Baltimore, MD, USA.
Abstract
OBJECTIVE: To evaluate the feasibility of high-frequency ultrasound and ultrasound elastography (USE) in discriminating benign from malignant skin lesions in a prospective cohort study and to introduce the use of a "strain ratio" for evaluation of skin lesions. METHODS: A commercial ultrasound system with a 14-MHz transducer was used to visualize skin lesions requiring biopsy on clinical evaluation. Anatomic ultrasound and USE imaging of the skin lesions was performed using 2- to 4-mm gel stand-off pads. A region of interest was manually selected over the area of each lesion with the lowest strain. The concept of a strain ratio of the compressibility of the normal skin at the corresponding layer to that of the least compressible region of a lesion in question was created and applied. This ratio was subsequently correlated with blind histopathological evaluation for malignancy. RESULTS: 55 patients were included in the study with a total of 67 lesions evaluated. 29 lesions were malignant and 38 benign. All malignant lesions had strain ratios ≥3.9. All benign lesions had strain ratios ≤3.0. A diagnostic value between 3.0 and 3.9 would result in 100% sensitivity and specificity in the characterization of these lesions as malignant. CONCLUSION: This pilot study demonstrated that USE plus strain ratio appears to be a promising modality in providing diagnostic determination between cancerous and benign primary solitary skin lesions prior to biopsy. ADVANCES IN KNOWLEDGE: This is the first reported study applying an original mathematical elastographic ratio, or strain ratio, to evaluate primary solitary skin lesions.
OBJECTIVE: To evaluate the feasibility of high-frequency ultrasound and ultrasound elastography (USE) in discriminating benign from malignant skin lesions in a prospective cohort study and to introduce the use of a "strain ratio" for evaluation of skin lesions. METHODS: A commercial ultrasound system with a 14-MHz transducer was used to visualize skin lesions requiring biopsy on clinical evaluation. Anatomic ultrasound and USE imaging of the skin lesions was performed using 2- to 4-mm gel stand-off pads. A region of interest was manually selected over the area of each lesion with the lowest strain. The concept of a strain ratio of the compressibility of the normal skin at the corresponding layer to that of the least compressible region of a lesion in question was created and applied. This ratio was subsequently correlated with blind histopathological evaluation for malignancy. RESULTS: 55 patients were included in the study with a total of 67 lesions evaluated. 29 lesions were malignant and 38 benign. All malignant lesions had strain ratios ≥3.9. All benign lesions had strain ratios ≤3.0. A diagnostic value between 3.0 and 3.9 would result in 100% sensitivity and specificity in the characterization of these lesions as malignant. CONCLUSION: This pilot study demonstrated that USE plus strain ratio appears to be a promising modality in providing diagnostic determination between cancerous and benign primary solitary skin lesions prior to biopsy. ADVANCES IN KNOWLEDGE: This is the first reported study applying an original mathematical elastographic ratio, or strain ratio, to evaluate primary solitary skin lesions.