背景：尚不清楚高频超声（HFUS）是否可以评估不可见的皮下病变。我们旨在探讨HFUS在隐形皮下病变中的诊断价值。
方法：前瞻性地从两个中心招募具有隐形皮下病变的患者。在接受活检或手术之前，每个病变由两名临床医师独立评估.一种仅通过临床检查提供临床诊断，另一种通过结合临床检查和HFUS信息提供综合诊断。诊断被归类为正确的，错误,不确定。共纳入355例患者的391个病灶，包括225个表皮样囊肿,77脂肪瘤,25个毛曲菌瘤，21例血管瘤，19皮肤纤维瘤,11隆突性皮肤纤维肉瘤（DFSP），7神经纤维瘤，和6个平滑肌瘤.以病理结果为金标准,比较了诊断性能。
结果：正确诊断的数量从单纯临床检查的185例（47.3％）增加到增加HFUS后的316例（80.8％）（P<0.05）。同时,不确定诊断率从143例(36.6%)下降到10例(2.6%)。使用HFUS，表皮样囊肿的准确性显着提高（59.6％vs.86.7%)，脂肪瘤（50.6%vs.94.8%），毛曲菌瘤（0%vs.48.0%），血管瘤（23.8%vs.57.1%)，和DFSP(0%与81.8%)(均p<0.05)。然而,HFUS并没有显著提高皮肤纤维瘤的诊断准确性(15.8%vs.21.1%,p>0.999),神经纤维瘤（42.9%vs.71.4%,p=0.625),或平滑肌瘤(16.7%vs.100%,p=0.063)。
结论：将HFUS和临床检查结合起来，可以普遍提高诊断的准确性，减少皮下隐形病变的不确定性。尤其是表皮样囊肿,脂肪瘤,毛曲菌瘤，血管瘤，和DFSP。然而,对于一些罕见的病变，HFUS无法提供有用的信息。
BACKGROUND: It is unknown whether high-frequency ultrasound (HFUS) can evaluate invisible subcutaneous lesions. We aimed to investigate the diagnostic value of HFUS in invisible subcutaneous lesions.
METHODS: Patients with invisible subcutaneous lesions were prospectively recruited from two centres. Before undergoing biopsy or surgery, each lesion was independently evaluated by two clinicians. One provides a clinical diagnosis by only clinical examination and the other provides an integrated diagnosis by combining clinical examination and HFUS information. Diagnoses were classified as correct, wrong, and indeterminate. A total of 391 lesions from 355 patients were enrolled, including 225 epidermoid cysts, 77 lipomas, 25 pilomatrixomas, 21 haemangiomas, 19 dermatofibromas, 11 dermatofibrosarcoma protuberans (DFSP), 7 neurofibromas, and 6 leiomyomas. Using pathological results as the gold standard, diagnostic performance was compared.
RESULTS: The number of correct diagnoses increased from 185 (47.3%) by clinical examination alone to 316 (80.8%) after the addition of HFUS (P < 0.05). Meanwhile, the indeterminate diagnosis rate decreased from 143 (36.6%) to 10 (2.6%). Using HFUS, the accuracy improved significantly for epidermoid cysts (59.6% vs. 86.7%), lipomas (50.6% vs. 94.8%), pilomatrixomas (0% vs. 48.0%), haemangiomas (23.8% vs. 57.1%), and DFSPs (0% vs. 81.8%) (all p < 0.05). However, HFUS did not significantly improve the diagnostic accuracy of dermatofibromas (15.8% vs. 21.1%, p > 0.999), neurofibromas (42.9% vs. 71.4%, p = 0.625), or leiomyomas (16.7% vs. 100%, p = 0.063).
CONCLUSIONS: Combining HFUS and clinical examination can generally improve the diagnostic accuracy and decrease the indeterminacy of invisible subcutaneous lesions, especially epidermoid cysts, lipomas, pilomatrixomas, haemangiomas, and DFSPs. However, for some rare lesions, HFUS cannot provide useful information.
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