High‐frequency ultrasound for diagnosing skin cancer in adults
Background Early, accurate detection of all skin cancer types is essential to guide appropriate management and to improve morbidity and survival. Melanoma and squamous cell carcinoma (SCC) are high‐risk skin cancers with the potential to metastasise and ultimately lead to death, whereas basal cell c...
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| creator | Dinnes, Jacqueline Bamber, Jeffrey Chuchu, Naomi Bayliss, Susan E Takwoingi, Yemisi Davenport, Clare Godfrey, Kathie O'Sullivan, Colette Matin, Rubeta N Deeks, Jonathan J Williams, Hywel C Dinnes, Jacqueline |
| description | Background
Early, accurate detection of all skin cancer types is essential to guide appropriate management and to improve morbidity and survival. Melanoma and squamous cell carcinoma (SCC) are high‐risk skin cancers with the potential to metastasise and ultimately lead to death, whereas basal cell carcinoma (BCC) is usually localised, with potential to infiltrate and damage surrounding tissue. Anxiety around missing early curable cases needs to be balanced against inappropriate referral and unnecessary excision of benign lesions. Ultrasound is a non‐invasive imaging technique that relies on the measurement of sound wave reflections from the tissues of the body. At lower frequencies, the deeper structures of the body such as the internal organs can be visualised, while high‐frequency ultrasound (HFUS) with transducer frequencies of 20 MHz or more has a much lower depth of tissue penetration but produces a higher resolution image of tissues and structures closer to the skin surface. Used in conjunction with clinical and/or dermoscopic examination of suspected skin cancer, HFUS may offer additional diagnostic information compared to other technologies.
Objectives
To assess the diagnostic accuracy of HFUS to assist in the diagnosis of a) cutaneous invasive melanoma and atypical intraepidermal melanocytic variants, b) cutaneous squamous cell carcinoma (cSCC), and c) basal cell carcinoma (BCC) in adults.
Search methods
We undertook a comprehensive search of the following databases from inception up to August 2016: Cochrane Central Register of Controlled Trials; MEDLINE; Embase; CINAHL; CPCI; Zetoc; Science Citation Index; US National Institutes of Health Ongoing Trials Register; NIHR Clinical Research Network Portfolio Database; and the World Health Organization International Clinical Trials Registry Platform. We studied reference lists as well as published systematic review articles.
Selection criteria
Studies evaluating HFUS (20 MHz or more) in adults with lesions suspicious for melanoma, cSCC or BCC versus a reference standard of histological confirmation or clinical follow‐up.
Data collection and analysis
Two review authors independently extracted all data using a standardised data extraction and quality assessment form (based on QUADAS‐2). Due to scarcity of data and the poor quality of studies, we did not undertake a meta‐analysis for this review. For illustrative purposes, we plot estimates of sensitivity and specificity on coupled forest plots.
Main resu |
| doi_str_mv | 10.1002/14651858.CD013188 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6516989</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2162499819</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4488-fcd1e0e5d594e415a29e84979eeca664e0894eb6d56c0c4e4f0cbe68153a545c3</originalsourceid><addsrcrecordid>eNp1kEtOAzEMhiMEgvI4ABs0SzaFZCZJkw0CladUiQ2sozTjmQamCSQdUHccgTNyEjLqA1iwsmV__m3_CB0SfEIwzk8J5YwIJk6Gl5gURIgN1Otq_a64-SvfQbsxPmFccJkPttFOgVlOuCh66PzW1pOvj88qwGsLzsyztpkFHX3ryqzyISutrp2P1tVZfLYuM9oZCFnKdJnQuI-2Kt1EOFjGPfR4ffUwvO2P7m_uhhejvqFUiH5lSgIYWMkkBUqYziUIKgcSwGjOKWCRGmNeMm6wSUiFzRi4IKzQjDJT7KGzhe5LO55CacClMxv1EuxUh7ny2qq_HWcnqvZvKlnEpZBJ4HgpEHx6Nc7U1EYDTaMd-DaqZEhOpRSkQ8kCNcHHGKBaryFYdc6rlfNq5XyaOfp933piZXUCxAJ4tw3MlfFmEtLq_yV_tL8BKJeQsQ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2162499819</pqid></control><display><type>article</type><title>High‐frequency ultrasound for diagnosing skin cancer in adults</title><source>MEDLINE</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><source>Cochrane Library</source><creator>Dinnes, Jacqueline ; Bamber, Jeffrey ; Chuchu, Naomi ; Bayliss, Susan E ; Takwoingi, Yemisi ; Davenport, Clare ; Godfrey, Kathie ; O'Sullivan, Colette ; Matin, Rubeta N ; Deeks, Jonathan J ; Williams, Hywel C ; Dinnes, Jacqueline</creator><creatorcontrib>Dinnes, Jacqueline ; Bamber, Jeffrey ; Chuchu, Naomi ; Bayliss, Susan E ; Takwoingi, Yemisi ; Davenport, Clare ; Godfrey, Kathie ; O'Sullivan, Colette ; Matin, Rubeta N ; Deeks, Jonathan J ; Williams, Hywel C ; Dinnes, Jacqueline ; Cochrane Skin Cancer Diagnostic Test Accuracy Group</creatorcontrib><description>Background
Early, accurate detection of all skin cancer types is essential to guide appropriate management and to improve morbidity and survival. Melanoma and squamous cell carcinoma (SCC) are high‐risk skin cancers with the potential to metastasise and ultimately lead to death, whereas basal cell carcinoma (BCC) is usually localised, with potential to infiltrate and damage surrounding tissue. Anxiety around missing early curable cases needs to be balanced against inappropriate referral and unnecessary excision of benign lesions. Ultrasound is a non‐invasive imaging technique that relies on the measurement of sound wave reflections from the tissues of the body. At lower frequencies, the deeper structures of the body such as the internal organs can be visualised, while high‐frequency ultrasound (HFUS) with transducer frequencies of 20 MHz or more has a much lower depth of tissue penetration but produces a higher resolution image of tissues and structures closer to the skin surface. Used in conjunction with clinical and/or dermoscopic examination of suspected skin cancer, HFUS may offer additional diagnostic information compared to other technologies.
Objectives
To assess the diagnostic accuracy of HFUS to assist in the diagnosis of a) cutaneous invasive melanoma and atypical intraepidermal melanocytic variants, b) cutaneous squamous cell carcinoma (cSCC), and c) basal cell carcinoma (BCC) in adults.
Search methods
We undertook a comprehensive search of the following databases from inception up to August 2016: Cochrane Central Register of Controlled Trials; MEDLINE; Embase; CINAHL; CPCI; Zetoc; Science Citation Index; US National Institutes of Health Ongoing Trials Register; NIHR Clinical Research Network Portfolio Database; and the World Health Organization International Clinical Trials Registry Platform. We studied reference lists as well as published systematic review articles.
Selection criteria
Studies evaluating HFUS (20 MHz or more) in adults with lesions suspicious for melanoma, cSCC or BCC versus a reference standard of histological confirmation or clinical follow‐up.
Data collection and analysis
Two review authors independently extracted all data using a standardised data extraction and quality assessment form (based on QUADAS‐2). Due to scarcity of data and the poor quality of studies, we did not undertake a meta‐analysis for this review. For illustrative purposes, we plot estimates of sensitivity and specificity on coupled forest plots.
Main results
We included six studies, providing 29 datasets: 20 for diagnosis of melanoma (1125 lesions and 242 melanomas) and 9 for diagnosis of BCC (993 lesions and 119 BCCs). We did not identify any data relating to the diagnosis of cSCC.
Studies were generally poorly reported, limiting judgements of methodological quality. Half the studies did not set out to establish test accuracy, and all should be considered preliminary evaluations of the potential usefulness of HFUS. There were particularly high concerns for applicability of findings due to selective study populations and data‐driven thresholds for test positivity. Studies reporting qualitative assessments of HFUS images excluded up to 22% of lesions (including some melanomas) due to lack of visualisation in the test.
Derived sensitivities for qualitative HFUS characteristics were at least 83% (95% CI 75% to 90%) for the detection of melanoma; the combination of three features (lesions appearing hypoechoic, homogenous and well defined) demonstrating 100% sensitivity in two studies (lower limits of the 95% CIs were 94% and 82%), with variable corresponding specificities of 33% (95% CI 20% to 48%) and 73% (95% CI 57% to 85%), respectively. Quantitative measurement of HFUS outputs in two studies enabled decision thresholds to be set to achieve 100% sensitivity; specificities were 93% (95% CI 77% to 99%) and 65% (95% CI 51% to 76%). It was not possible to make summary statements regarding HFUS accuracy for the diagnosis of BCC due to highly variable sensitivities and specificities.
Authors' conclusions
Insufficient data are available on the potential value of HFUS in the diagnosis of melanoma or BCC. Given the between‐study heterogeneity, unclear to low methodological quality and limited volume of evidence, we cannot draw any implications for practice. The main value of the preliminary studies included may be in providing guidance on the possible components of new diagnostic rules for diagnosis of melanoma or BCC using HFUS that will require future evaluation. A prospective evaluation of HFUS added to visual inspection and dermoscopy alone in a standard healthcare setting, with a clearly defined and representative population of participants, would be required for a full and proper evaluation of accuracy.</description><identifier>ISSN: 1465-1858</identifier><identifier>EISSN: 1465-1858</identifier><identifier>EISSN: 1469-493X</identifier><identifier>DOI: 10.1002/14651858.CD013188</identifier><identifier>PMID: 30521683</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Ltd</publisher><subject>Adult ; Cancer ; Carcinoma, Basal Cell ; Carcinoma, Basal Cell - diagnostic imaging ; Carcinoma, Squamous Cell ; Carcinoma, Squamous Cell - diagnostic imaging ; Diagnosis ; Diagnostic test accuracy ; Diagnostic tests ; Humans ; Malignant melanoma ; Medicine General & Introductory Medical Sciences ; Melanoma ; Melanoma - diagnostic imaging ; Melanoma, Cutaneous Malignant ; Sensitivity and Specificity ; Skin ; Skin Neoplasms ; Skin Neoplasms - diagnostic imaging ; Ultrasonography ; Ultrasonography - methods ; X. TUMOURS AND CYSTS OF THE SKIN AND APPENDAGES ; X4 Malignant melanoma</subject><ispartof>Cochrane database of systematic reviews, 2018-12, Vol.2018 (12), p.CD013188-CD013188</ispartof><rights>Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4488-fcd1e0e5d594e415a29e84979eeca664e0894eb6d56c0c4e4f0cbe68153a545c3</citedby><cites>FETCH-LOGICAL-c4488-fcd1e0e5d594e415a29e84979eeca664e0894eb6d56c0c4e4f0cbe68153a545c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30521683$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Dinnes, Jacqueline</creatorcontrib><creatorcontrib>Bamber, Jeffrey</creatorcontrib><creatorcontrib>Chuchu, Naomi</creatorcontrib><creatorcontrib>Bayliss, Susan E</creatorcontrib><creatorcontrib>Takwoingi, Yemisi</creatorcontrib><creatorcontrib>Davenport, Clare</creatorcontrib><creatorcontrib>Godfrey, Kathie</creatorcontrib><creatorcontrib>O'Sullivan, Colette</creatorcontrib><creatorcontrib>Matin, Rubeta N</creatorcontrib><creatorcontrib>Deeks, Jonathan J</creatorcontrib><creatorcontrib>Williams, Hywel C</creatorcontrib><creatorcontrib>Dinnes, Jacqueline</creatorcontrib><creatorcontrib>Cochrane Skin Cancer Diagnostic Test Accuracy Group</creatorcontrib><title>High‐frequency ultrasound for diagnosing skin cancer in adults</title><title>Cochrane database of systematic reviews</title><addtitle>Cochrane Database Syst Rev</addtitle><description>Background
Early, accurate detection of all skin cancer types is essential to guide appropriate management and to improve morbidity and survival. Melanoma and squamous cell carcinoma (SCC) are high‐risk skin cancers with the potential to metastasise and ultimately lead to death, whereas basal cell carcinoma (BCC) is usually localised, with potential to infiltrate and damage surrounding tissue. Anxiety around missing early curable cases needs to be balanced against inappropriate referral and unnecessary excision of benign lesions. Ultrasound is a non‐invasive imaging technique that relies on the measurement of sound wave reflections from the tissues of the body. At lower frequencies, the deeper structures of the body such as the internal organs can be visualised, while high‐frequency ultrasound (HFUS) with transducer frequencies of 20 MHz or more has a much lower depth of tissue penetration but produces a higher resolution image of tissues and structures closer to the skin surface. Used in conjunction with clinical and/or dermoscopic examination of suspected skin cancer, HFUS may offer additional diagnostic information compared to other technologies.
Objectives
To assess the diagnostic accuracy of HFUS to assist in the diagnosis of a) cutaneous invasive melanoma and atypical intraepidermal melanocytic variants, b) cutaneous squamous cell carcinoma (cSCC), and c) basal cell carcinoma (BCC) in adults.
Search methods
We undertook a comprehensive search of the following databases from inception up to August 2016: Cochrane Central Register of Controlled Trials; MEDLINE; Embase; CINAHL; CPCI; Zetoc; Science Citation Index; US National Institutes of Health Ongoing Trials Register; NIHR Clinical Research Network Portfolio Database; and the World Health Organization International Clinical Trials Registry Platform. We studied reference lists as well as published systematic review articles.
Selection criteria
Studies evaluating HFUS (20 MHz or more) in adults with lesions suspicious for melanoma, cSCC or BCC versus a reference standard of histological confirmation or clinical follow‐up.
Data collection and analysis
Two review authors independently extracted all data using a standardised data extraction and quality assessment form (based on QUADAS‐2). Due to scarcity of data and the poor quality of studies, we did not undertake a meta‐analysis for this review. For illustrative purposes, we plot estimates of sensitivity and specificity on coupled forest plots.
Main results
We included six studies, providing 29 datasets: 20 for diagnosis of melanoma (1125 lesions and 242 melanomas) and 9 for diagnosis of BCC (993 lesions and 119 BCCs). We did not identify any data relating to the diagnosis of cSCC.
Studies were generally poorly reported, limiting judgements of methodological quality. Half the studies did not set out to establish test accuracy, and all should be considered preliminary evaluations of the potential usefulness of HFUS. There were particularly high concerns for applicability of findings due to selective study populations and data‐driven thresholds for test positivity. Studies reporting qualitative assessments of HFUS images excluded up to 22% of lesions (including some melanomas) due to lack of visualisation in the test.
Derived sensitivities for qualitative HFUS characteristics were at least 83% (95% CI 75% to 90%) for the detection of melanoma; the combination of three features (lesions appearing hypoechoic, homogenous and well defined) demonstrating 100% sensitivity in two studies (lower limits of the 95% CIs were 94% and 82%), with variable corresponding specificities of 33% (95% CI 20% to 48%) and 73% (95% CI 57% to 85%), respectively. Quantitative measurement of HFUS outputs in two studies enabled decision thresholds to be set to achieve 100% sensitivity; specificities were 93% (95% CI 77% to 99%) and 65% (95% CI 51% to 76%). It was not possible to make summary statements regarding HFUS accuracy for the diagnosis of BCC due to highly variable sensitivities and specificities.
Authors' conclusions
Insufficient data are available on the potential value of HFUS in the diagnosis of melanoma or BCC. Given the between‐study heterogeneity, unclear to low methodological quality and limited volume of evidence, we cannot draw any implications for practice. The main value of the preliminary studies included may be in providing guidance on the possible components of new diagnostic rules for diagnosis of melanoma or BCC using HFUS that will require future evaluation. A prospective evaluation of HFUS added to visual inspection and dermoscopy alone in a standard healthcare setting, with a clearly defined and representative population of participants, would be required for a full and proper evaluation of accuracy.</description><subject>Adult</subject><subject>Cancer</subject><subject>Carcinoma, Basal Cell</subject><subject>Carcinoma, Basal Cell - diagnostic imaging</subject><subject>Carcinoma, Squamous Cell</subject><subject>Carcinoma, Squamous Cell - diagnostic imaging</subject><subject>Diagnosis</subject><subject>Diagnostic test accuracy</subject><subject>Diagnostic tests</subject><subject>Humans</subject><subject>Malignant melanoma</subject><subject>Medicine General & Introductory Medical Sciences</subject><subject>Melanoma</subject><subject>Melanoma - diagnostic imaging</subject><subject>Melanoma, Cutaneous Malignant</subject><subject>Sensitivity and Specificity</subject><subject>Skin</subject><subject>Skin Neoplasms</subject><subject>Skin Neoplasms - diagnostic imaging</subject><subject>Ultrasonography</subject><subject>Ultrasonography - methods</subject><subject>X. TUMOURS AND CYSTS OF THE SKIN AND APPENDAGES</subject><subject>X4 Malignant melanoma</subject><issn>1465-1858</issn><issn>1465-1858</issn><issn>1469-493X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>RWY</sourceid><sourceid>EIF</sourceid><recordid>eNp1kEtOAzEMhiMEgvI4ABs0SzaFZCZJkw0CladUiQ2sozTjmQamCSQdUHccgTNyEjLqA1iwsmV__m3_CB0SfEIwzk8J5YwIJk6Gl5gURIgN1Otq_a64-SvfQbsxPmFccJkPttFOgVlOuCh66PzW1pOvj88qwGsLzsyztpkFHX3ryqzyISutrp2P1tVZfLYuM9oZCFnKdJnQuI-2Kt1EOFjGPfR4ffUwvO2P7m_uhhejvqFUiH5lSgIYWMkkBUqYziUIKgcSwGjOKWCRGmNeMm6wSUiFzRi4IKzQjDJT7KGzhe5LO55CacClMxv1EuxUh7ny2qq_HWcnqvZvKlnEpZBJ4HgpEHx6Nc7U1EYDTaMd-DaqZEhOpRSkQ8kCNcHHGKBaryFYdc6rlfNq5XyaOfp933piZXUCxAJ4tw3MlfFmEtLq_yV_tL8BKJeQsQ</recordid><startdate>20181204</startdate><enddate>20181204</enddate><creator>Dinnes, Jacqueline</creator><creator>Bamber, Jeffrey</creator><creator>Chuchu, Naomi</creator><creator>Bayliss, Susan E</creator><creator>Takwoingi, Yemisi</creator><creator>Davenport, Clare</creator><creator>Godfrey, Kathie</creator><creator>O'Sullivan, Colette</creator><creator>Matin, Rubeta N</creator><creator>Deeks, Jonathan J</creator><creator>Williams, Hywel C</creator><creator>Dinnes, Jacqueline</creator><general>John Wiley & Sons, Ltd</general><scope>7PX</scope><scope>RWY</scope><scope>ZYTZH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20181204</creationdate><title>High‐frequency ultrasound for diagnosing skin cancer in adults</title><author>Dinnes, Jacqueline ; Bamber, Jeffrey ; Chuchu, Naomi ; Bayliss, Susan E ; Takwoingi, Yemisi ; Davenport, Clare ; Godfrey, Kathie ; O'Sullivan, Colette ; Matin, Rubeta N ; Deeks, Jonathan J ; Williams, Hywel C ; Dinnes, Jacqueline</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4488-fcd1e0e5d594e415a29e84979eeca664e0894eb6d56c0c4e4f0cbe68153a545c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adult</topic><topic>Cancer</topic><topic>Carcinoma, Basal Cell</topic><topic>Carcinoma, Basal Cell - diagnostic imaging</topic><topic>Carcinoma, Squamous Cell</topic><topic>Carcinoma, Squamous Cell - diagnostic imaging</topic><topic>Diagnosis</topic><topic>Diagnostic test accuracy</topic><topic>Diagnostic tests</topic><topic>Humans</topic><topic>Malignant melanoma</topic><topic>Medicine General & Introductory Medical Sciences</topic><topic>Melanoma</topic><topic>Melanoma - diagnostic imaging</topic><topic>Melanoma, Cutaneous Malignant</topic><topic>Sensitivity and Specificity</topic><topic>Skin</topic><topic>Skin Neoplasms</topic><topic>Skin Neoplasms - diagnostic imaging</topic><topic>Ultrasonography</topic><topic>Ultrasonography - methods</topic><topic>X. TUMOURS AND CYSTS OF THE SKIN AND APPENDAGES</topic><topic>X4 Malignant melanoma</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Dinnes, Jacqueline</creatorcontrib><creatorcontrib>Bamber, Jeffrey</creatorcontrib><creatorcontrib>Chuchu, Naomi</creatorcontrib><creatorcontrib>Bayliss, Susan E</creatorcontrib><creatorcontrib>Takwoingi, Yemisi</creatorcontrib><creatorcontrib>Davenport, Clare</creatorcontrib><creatorcontrib>Godfrey, Kathie</creatorcontrib><creatorcontrib>O'Sullivan, Colette</creatorcontrib><creatorcontrib>Matin, Rubeta N</creatorcontrib><creatorcontrib>Deeks, Jonathan J</creatorcontrib><creatorcontrib>Williams, Hywel C</creatorcontrib><creatorcontrib>Dinnes, Jacqueline</creatorcontrib><creatorcontrib>Cochrane Skin Cancer Diagnostic Test Accuracy Group</creatorcontrib><collection>Wiley-Blackwell Cochrane Library</collection><collection>Cochrane Library</collection><collection>Cochrane Library (Open Aceess)</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Cochrane database of systematic reviews</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Dinnes, Jacqueline</au><au>Bamber, Jeffrey</au><au>Chuchu, Naomi</au><au>Bayliss, Susan E</au><au>Takwoingi, Yemisi</au><au>Davenport, Clare</au><au>Godfrey, Kathie</au><au>O'Sullivan, Colette</au><au>Matin, Rubeta N</au><au>Deeks, Jonathan J</au><au>Williams, Hywel C</au><au>Dinnes, Jacqueline</au><aucorp>Cochrane Skin Cancer Diagnostic Test Accuracy Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>High‐frequency ultrasound for diagnosing skin cancer in adults</atitle><jtitle>Cochrane database of systematic reviews</jtitle><addtitle>Cochrane Database Syst Rev</addtitle><date>2018-12-04</date><risdate>2018</risdate><volume>2018</volume><issue>12</issue><spage>CD013188</spage><epage>CD013188</epage><pages>CD013188-CD013188</pages><issn>1465-1858</issn><eissn>1465-1858</eissn><eissn>1469-493X</eissn><abstract>Background
Early, accurate detection of all skin cancer types is essential to guide appropriate management and to improve morbidity and survival. Melanoma and squamous cell carcinoma (SCC) are high‐risk skin cancers with the potential to metastasise and ultimately lead to death, whereas basal cell carcinoma (BCC) is usually localised, with potential to infiltrate and damage surrounding tissue. Anxiety around missing early curable cases needs to be balanced against inappropriate referral and unnecessary excision of benign lesions. Ultrasound is a non‐invasive imaging technique that relies on the measurement of sound wave reflections from the tissues of the body. At lower frequencies, the deeper structures of the body such as the internal organs can be visualised, while high‐frequency ultrasound (HFUS) with transducer frequencies of 20 MHz or more has a much lower depth of tissue penetration but produces a higher resolution image of tissues and structures closer to the skin surface. Used in conjunction with clinical and/or dermoscopic examination of suspected skin cancer, HFUS may offer additional diagnostic information compared to other technologies.
Objectives
To assess the diagnostic accuracy of HFUS to assist in the diagnosis of a) cutaneous invasive melanoma and atypical intraepidermal melanocytic variants, b) cutaneous squamous cell carcinoma (cSCC), and c) basal cell carcinoma (BCC) in adults.
Search methods
We undertook a comprehensive search of the following databases from inception up to August 2016: Cochrane Central Register of Controlled Trials; MEDLINE; Embase; CINAHL; CPCI; Zetoc; Science Citation Index; US National Institutes of Health Ongoing Trials Register; NIHR Clinical Research Network Portfolio Database; and the World Health Organization International Clinical Trials Registry Platform. We studied reference lists as well as published systematic review articles.
Selection criteria
Studies evaluating HFUS (20 MHz or more) in adults with lesions suspicious for melanoma, cSCC or BCC versus a reference standard of histological confirmation or clinical follow‐up.
Data collection and analysis
Two review authors independently extracted all data using a standardised data extraction and quality assessment form (based on QUADAS‐2). Due to scarcity of data and the poor quality of studies, we did not undertake a meta‐analysis for this review. For illustrative purposes, we plot estimates of sensitivity and specificity on coupled forest plots.
Main results
We included six studies, providing 29 datasets: 20 for diagnosis of melanoma (1125 lesions and 242 melanomas) and 9 for diagnosis of BCC (993 lesions and 119 BCCs). We did not identify any data relating to the diagnosis of cSCC.
Studies were generally poorly reported, limiting judgements of methodological quality. Half the studies did not set out to establish test accuracy, and all should be considered preliminary evaluations of the potential usefulness of HFUS. There were particularly high concerns for applicability of findings due to selective study populations and data‐driven thresholds for test positivity. Studies reporting qualitative assessments of HFUS images excluded up to 22% of lesions (including some melanomas) due to lack of visualisation in the test.
Derived sensitivities for qualitative HFUS characteristics were at least 83% (95% CI 75% to 90%) for the detection of melanoma; the combination of three features (lesions appearing hypoechoic, homogenous and well defined) demonstrating 100% sensitivity in two studies (lower limits of the 95% CIs were 94% and 82%), with variable corresponding specificities of 33% (95% CI 20% to 48%) and 73% (95% CI 57% to 85%), respectively. Quantitative measurement of HFUS outputs in two studies enabled decision thresholds to be set to achieve 100% sensitivity; specificities were 93% (95% CI 77% to 99%) and 65% (95% CI 51% to 76%). It was not possible to make summary statements regarding HFUS accuracy for the diagnosis of BCC due to highly variable sensitivities and specificities.
Authors' conclusions
Insufficient data are available on the potential value of HFUS in the diagnosis of melanoma or BCC. Given the between‐study heterogeneity, unclear to low methodological quality and limited volume of evidence, we cannot draw any implications for practice. The main value of the preliminary studies included may be in providing guidance on the possible components of new diagnostic rules for diagnosis of melanoma or BCC using HFUS that will require future evaluation. A prospective evaluation of HFUS added to visual inspection and dermoscopy alone in a standard healthcare setting, with a clearly defined and representative population of participants, would be required for a full and proper evaluation of accuracy.</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>30521683</pmid><doi>10.1002/14651858.CD013188</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1465-1858 |
| ispartof | Cochrane database of systematic reviews, 2018-12, Vol.2018 (12), p.CD013188-CD013188 |
| issn | 1465-1858 1465-1858 1469-493X |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6516989 |
| source | MEDLINE; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection; Cochrane Library |
| subjects | Adult Cancer Carcinoma, Basal Cell Carcinoma, Basal Cell - diagnostic imaging Carcinoma, Squamous Cell Carcinoma, Squamous Cell - diagnostic imaging Diagnosis Diagnostic test accuracy Diagnostic tests Humans Malignant melanoma Medicine General & Introductory Medical Sciences Melanoma Melanoma - diagnostic imaging Melanoma, Cutaneous Malignant Sensitivity and Specificity Skin Skin Neoplasms Skin Neoplasms - diagnostic imaging Ultrasonography Ultrasonography - methods X. TUMOURS AND CYSTS OF THE SKIN AND APPENDAGES X4 Malignant melanoma |
| title | High‐frequency ultrasound for diagnosing skin cancer in adults |
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