Integrative Analysis And Differential Diagnosis Of Skin Solid Tumours Using Ultrasonogaphic Multimodality

Skin tumors are the most common tumor in human beings,and most of them are solid.At present,conventional ultrasound imaging(two-dimensional and color doppler ultrasound)has been widely used in the clinical diagnosis of skin tumors,which can provide information about morphology and blood flow perfusion about the tumors.However,the conventional ultrasound can not show the microcirculation and stiffness of the tumor,and there is no significant difference in differentiating between benign and malignant.In order to assess the skin solid tumor preoperatively,identify the US features of them,especially differentiate benign and malignant,facilitate the choice of surgical methods and postoperative management,our study tried to develop an integrative ultrasonogaphic multimodality for skin solid tumor.Pathological and immunohistochemistry results were the golden standards,69 patients(69 lesions)were performed by ultrasonographic multimodality in our hospital,including two-dimensional ultrasound,color doppler ultrasound,higher frequency ultrasound,contrast-enhanced ultrasound and elastography.The correlation between the measurement thickness of higher frequency ultrasound and the thickness of postoperative Breslow's was analyzed.Qualitative analysis of 69 lesions with contrast-enhanced ultrasound.Quantitatively evaluating the value of the time-intensity curve parameters in the differential diagnosis.Evaluating the application value of elastography.To summarize the diagnostic efficacy of conventional ultrasound and ultrasonic multimodality for skin solid tumors.Through this prospective study,we summarized the ultrasonographic features of most benign and malignant skin tumors.The benign tumors were hypoechoic solid neoplasm,boundary is clear,with homogeneous structure,except for a few pathological type(e.g.dermatofibroma,schwannoma),most benign tumors with no blood supply,blood flow signals(Adler Classification of CDFI)were 0-1,contrast-enhanced ultrasound perfusion pattern is slowly and a weak loading,elastic stiffness grade 1-3.The malignant tumors were no clear boundary,irregular shape,low or heterogeneous echo in the mass,and the blood flow signals were 2-3,and the contrast-enhanced ultrasound perfusion pattern were rapid diffuse homogeneity and high enhancement,or rapid inhomogeneity and high enhancement,with partial filling defect,elastic stiffness grade 4-5.There is a statistically significant difference between the benign andmalignant judgment of the skin solid tumors on the edge of the tumor in two-dimensional ultrasound and the Adler blood classification in the CDFI(P<0.001).Enhancement pattern,time-intensity curve's parameter such as peak,time to peak and sharpness,elasticity E score were statistically significant between benign and malignant tumors(p<0.05).The thickness of tumor obtained by higher frequency ultrasound was highly correlated with the pathological Breslow's results(r=0.957),The correlation test was statistically significant(p<0.05).In conclusion,the measurement of the skin solid tumors by higher frequency ultrasound is gradually close to the accuracy of histological pathology.Contrast-enhanced Ultrasound pattern and time-intensity curve parameters and elasticity score help to provide differential diagnosis information.Compared with conventional ultrasound,ultrasonogaphic multimodality imaging has improved significantly in diagnostic efficiency.These real-time,non-invasive,non-radiation,good repeatable imaging technique are of great significance for preoperative evaluation and treatment modality in skin solid tumors.