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Hobayan CGP, Gray AN, Waters MF, Mager LA, Kobayashi S, Essien EW, Ulman CA, Kaffenberger BH. Diagnostic accuracy of high-frequency ultrasound for cutaneous neoplasms: a narrative review of the literature. Arch Dermatol Res 2024; 316:419. [PMID: 38904763 PMCID: PMC11192820 DOI: 10.1007/s00403-024-03179-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 06/07/2024] [Accepted: 06/08/2024] [Indexed: 06/22/2024]
Abstract
High-frequency ultrasound has been used to visualize depth and vascularization of cutaneous neoplasms, but little has been synthesized as a review for a robust level of evidence about the diagnostic accuracy of high-frequency ultrasound in dermatology. A narrative review of the PubMed database was performed to establish the correlation between ultrasound findings and histopathologic/dermoscopic findings for cutaneous neoplasms. Articles were divided into the following four categories: melanocytic, keratinocytic/epidermal, appendageal, and soft tissue/neural neoplasms. Review of the literature revealed that ultrasound findings and histopathology findings were strongly correlated regarding the depth of a cutaneous neoplasm. Morphological characteristics were correlated primarily in soft tissue/neural neoplasms. Overall, there is a paucity of literature on the correlation between high-frequency ultrasound and histopathology of cutaneous neoplasms. Further studies are needed to investigate this correlation in various dermatologic conditions.
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Affiliation(s)
| | - Ashley N Gray
- Department of Dermatology, The Ohio State University, 540 Officecenter Place, Suite 240, Columbus, OH, 43230, USA
| | - Margo F Waters
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Layna A Mager
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Sonja Kobayashi
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Ellen W Essien
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Catherine A Ulman
- Department of Dermatology, The Ohio State University, 540 Officecenter Place, Suite 240, Columbus, OH, 43230, USA
| | - Benjamin H Kaffenberger
- Department of Dermatology, The Ohio State University, 540 Officecenter Place, Suite 240, Columbus, OH, 43230, USA.
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Zattar L, Wortsman X. Ultrasound of Benign Cutaneous Tumors and Pseudotumors: The Key Lesions. Semin Ultrasound CT MR 2024; 45:192-215. [PMID: 38056792 DOI: 10.1053/j.sult.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
Benign cutaneous tumors are commonly seen in daily practice. Most of these lesions are diagnosed based on clinical appearance, but in some cases, clinical findings are nonspecific. A diagnostic imaging exam is indicated to provide additional information, and the first choice for studying dermatologic lesions is a high-frequency color Doppler ultrasound, a noninvasive technique that can play a relevant role in all cases and give important anatomical information for final diagnosis and proper clinical management. This article aims to show the most common benign skin lesions emphasizing clinical-sonographic correlation and familiarizing radiologists with the sonographic appearance of the key benign cutaneous tumors.
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Affiliation(s)
- Luciana Zattar
- Department of Radiology, Hospital Sírio-Libanês, São Paulo, SP, Brazil; Radiology, Radioderm Serviços Médicos, Florianópolis, SC, Brazil.
| | - Ximena Wortsman
- Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Santiago, Chile; Department of Dermatology, Faculty of Medicine, Universidad de Chile, Santiago, Chile; Department of Dermatology, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
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3
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Wallworth TM, Husson C, Roberie D, Rooks V. Post-traumatic pilomatricoma presenting as rapidly enlarging pediatric scalp mass. Radiol Case Rep 2024; 19:1452-1456. [PMID: 38298907 PMCID: PMC10828587 DOI: 10.1016/j.radcr.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 02/02/2024] Open
Abstract
Pilomatricomas (PM) are benign neoplasms that arise from hair follicle matrix cells. They are one of the most frequently excised pediatric skin masses. A typical clinical presentation is a slow growing, painless, firm, superficial mass in the head and neck of a child. We present a rare presentation of PM. A preschool aged girl presented with an enlarging scalp mass following a history of minor blunt trauma to the area. Two months prior, the child sustained a ground level fall and subsequently developed a painless "bump" at the site of injury on the scalp. The ``bump" was initially the size of a "mosquito bite" and enlarged to the size of a "ping pong ball". Given the rapid progression and history of trauma, there was a broad differential diagnosis. An extensive workup including sonography, computed tomography, MRI, and biopsy were performed. The final pathologic diagnosis was confirmed as pilomatricoma. An atypical presentation of PM in a child can mimic a wide variety of pathology. Our case demonstrates unusual features of rapid enlargement and preceding trauma. With the widespread use of sonography for evaluation of superficial lesions, the radiologist may be the first to suspect the diagnosis of PM. Knowledge of the typical imaging findings in PM can be valuable, especially in more unusual cases.
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Affiliation(s)
- Taylor M. Wallworth
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | | - Dustin Roberie
- Department of Radiology, Tripler Army Medical Center, Honolulu, HI, USA
| | - Veronica Rooks
- Department of Radiology, Tripler Army Medical Center, Honolulu, HI, USA
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Zhu H, Wu S. Integrating vascularity into the pattern classification of pilomatricomas on ultrasound provides a more competent approach for discriminative evaluation. Skin Res Technol 2024; 30:e13585. [PMID: 38279551 PMCID: PMC10818091 DOI: 10.1111/srt.13585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 01/08/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND Pilomatricoma has various manifestations on color Doppler ultrasound, and a differential diagnosis is challenging. The objective of this study was to investigate which characteristics of skin lesions on color Doppler ultrasound are effective in distinguishing pilomatricoma from epidermoid cyst and dermatofibrosarcoma protuberans. MATERIALS AND METHODS Records of patients with pilomatricomas (n = 63), epidermoid cysts (n = 76), and dermatofibrosarcoma protuberans (n = 19) who underwent color Doppler ultrasound evaluation and surgical excision were reviewed. The anatomical distribution and color Doppler ultrasound characteristics of these lesions were analyzed. The 63 pilomatricomas were categorized into five types based on their color Doppler ultrasound characteristics, and the roles of these five types in the differential diagnosis of the aforementioned diseases were studied. RESULTS Pilomatricomas, epidermoid cysts, and dermatofibrosarcoma protuberans exhibited some similar characteristics. Dominantly markedly hyperechoic or hyperechoic appearance, posterior acoustic shadowing, and the presence of vascularity were the major characteristics of pilomatricomas. The pilomatricomas could be categorized into five types, with type II having a diagnostic performance of sensitivity of 65.08%, specificity of 98.95%, area under the receiver operating characteristic curve (AUC) of 0.743, positive predictive value of 97.62%, and negative predictive value of 81.03% for the diagnosis of the aforementioned skin diseases. CONCLUSION A combination of dominantly markedly hyperechoic or hyperechoic appearance, posterior acoustic shadowing, and the presence of vascularity exhibits higher diagnostic performance for the differential diagnosis of pilomatricomas, epidermoid cysts, and dermatofibrosarcoma protuberans.
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Affiliation(s)
- Huiling Zhu
- Department of UltrasoundThe First Affiliated Hospital of Hainan Medical UniversityHaikouChina
| | - Size Wu
- Department of UltrasoundThe First Affiliated Hospital of Hainan Medical UniversityHaikouChina
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Wortsman X. Key Points to Select a Device for Dermatologic Ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:521-545. [PMID: 36394307 DOI: 10.1002/jum.16000] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 04/19/2022] [Indexed: 05/26/2023]
Abstract
What points to consider when selecting a device for practicing dermatologic ultrasound is an excellent question. After we met the requisites published in the guidelines for practicing dermatologic ultrasound, it is necessary to consider the main objective of the use because it is not the same to be focused mostly on the avoidance of the puncture of important facial vessels such as the case of injectors of cosmetic fillers in comparison to the use of operators that need to deal with the diagnosis and monitoring of a wide range of dermatologic pathologies. Currently, a broad variety of ultrasound devices meets the minimum requirements for practicing these examinations in the market. Thus, small, portable, and high-end devices may present advantages and limitations that must be balanced according to the primary purposes and the budget. Moreover, the shape and footprint of the probes can make difficult or facilitate a dermatologic procedure. Other points to consider are the type of storage and the need for technical service. In summary, there are key points that we need to consider when we select a dermatologic ultrasound device in dermatology or aesthetics.
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Affiliation(s)
- Ximena Wortsman
- Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Santiago, Chile
- Department of Dermatology, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- Department of Dermatology, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
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Llanos D, de la Pedraja I, Campos L, Armijo J, Ávila LF. Imaging palpable tumors in pediatrics: Part 2. RADIOLOGIA 2023; 65:43-54. [PMID: 36842785 DOI: 10.1016/j.rxeng.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/03/2022] [Indexed: 02/28/2023]
Abstract
Palpable tumors in children are a common reason for consulting a radiologist. The origin of these lesions varies widely, and although they are common, classic radiology books do not cover some of them. This series of two articles aims to review the clinical and radiological characteristics of a selection of palpable tumors in children that radiologists need to be familiar with.
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Affiliation(s)
- D Llanos
- Servicio de Radiodiagnóstico, Hospital Universitario Clínico San Carlos, Madrid, Spain.
| | - I de la Pedraja
- Servicio de Radiodiagnóstico, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - L Campos
- Servicio de Dermatología, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - J Armijo
- Servicio de Radiodiagnóstico, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - L F Ávila
- Servicio de Cirugía Pediátrica, Hospital Universitario Clínico San Carlos, Madrid, Spain
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Llanos D, de la Pedraja I, Campos L, Armijo J, Ávila L. Radiología de las tumoraciones palpables en el paciente pediátrico. Parte 2. RADIOLOGIA 2023. [DOI: 10.1016/j.rx.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Giacalone S, Spigariolo CB, Brena M, Nazzaro G. The role of high-frequency ultrasound in the clinical management of multiple pilomatricomas. Int J Dermatol 2022; 61:e465-e467. [PMID: 35094382 DOI: 10.1111/ijd.16100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 11/24/2021] [Accepted: 01/06/2022] [Indexed: 12/17/2022]
Affiliation(s)
- Serena Giacalone
- Department of Physiopathology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | | | - Michela Brena
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gianluca Nazzaro
- Department of Physiopathology and Transplantation, Università degli Studi di Milano, Milan, Italy.,Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Garcia C, Wortsman X, Bazaes-Nuñez D, Pelizzari M, Gonzalez S, Cossio ML, De Barbieri F. Skin sonography in children: a review. Pediatr Radiol 2022; 52:1687-1705. [PMID: 35821441 DOI: 10.1007/s00247-022-05434-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/29/2022] [Accepted: 06/15/2022] [Indexed: 11/30/2022]
Abstract
Skin lesions are not uncommon in children, and most of them are benign. However, they can be a matter of concern. Although in most cases the diagnosis can be suspected based on clinical history and physical examination, in some cases clinical findings are nonspecific. High-frequency color Doppler US is a noninvasive technique that can play a relevant role in these cases and give important anatomical information for final clinical management. US can be helpful to avoid unnecessary surgery, plan a surgical excision and avoid advanced imaging studies such as MRI and CT, which have a lower resolution for the skin. Different lesions can look similar on US, and clinical correlation is always important. The purpose of this article is to show a variety of skin lesions that occur in children, emphasizing clinical-sonographic correlation, and to familiarize pediatric radiologists with the US technique and sonographic appearance of common skin lesions in children.
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Affiliation(s)
- Cristian Garcia
- Department of Radiology, Pontificia Universidad Católica de Chile, 367 Marcoleta, 8330024, Santiago, Chile.
| | - Ximena Wortsman
- Department of Dermatology, Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Diego Bazaes-Nuñez
- Department of Radiology, Pontificia Universidad Católica de Chile, 367 Marcoleta, 8330024, Santiago, Chile
| | - Mario Pelizzari
- Department of Radiology, Universidad Católica de Córdoba, Ciudad de Córdoba, República Argentina.,Section of Pediatric Radiology, Instituto Oulton, Ciudad de Córdoba, República Argentina
| | - Sergio Gonzalez
- Department of Pathology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Maria-Laura Cossio
- Department of Dermatology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Florencia De Barbieri
- Department of Radiology, Pontificia Universidad Católica de Chile, 367 Marcoleta, 8330024, Santiago, Chile
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