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Depth determination of skin cancers treated with superficial brachytherapy: ultrasound vs. histopathology.

Ballester-Sánchez R, Pons-Llanas O, Llavador-Ros M, Botella-Estrada R, Ballester-Cuñat A, Tormo-Micó A, Javier Celadá-Álvarez F, Rodríguez-Villalba S, Santos-Ortega M, Ballester-Pallarés F, Perez-Calatayud J - J Contemp Brachytherapy (2014)

Bottom Line: Depth value differences with both modalities resulted patient dependent and then consequence of its uncertainty.According to the results, HFUS is less accurate at very shallow depths.In our clinical practice, we decided to prescribe at 3 mm depth when HFUS measurements give depth lesion values smaller than this value.

View Article: PubMed Central - PubMed

Affiliation: Dermatology Department, La Fe University and Polytechnic Hospital, Valencia.

ABSTRACT

Purpose: The purpose of this study is to compare high frequency ultrasonography (HFUS) and histpathologic assessment done by punch biopsy in order to determine depth of basal cell carcinoma (BCC), in both superficial and nodular BCCs prior to brachytherapy treatment.

Material and methods: This study includes 20 patients with 10 superficial and 10 nodular BCCs. First, punch biopsy was done to confirm the diagnosis and to measure tumour depth (Breslow rate). Subsequently, HFUS was done to measure tumour depth to search for correlation of these two techniques.

Results: Neither clear tendency nor significance of the punch biopsy vs. HFUS depth determination is observed. Depth value differences with both modalities resulted patient dependent and then consequence of its uncertainty. Conceptually, HFUS should determine the macroscopic lesion (gross tumour volume - GTV), while punch biopsy is able to detect the microscopic extension (clinical target volume - CTV). Uncertainties of HFUS are difficult to address, while punch biopsy is done just on a small lesion section, not necessarily the deepest one.

Conclusions: According to the results, HFUS is less accurate at very shallow depths. Nodular cases present higher depth determination differences than superficial ones. In our clinical practice, we decided to prescribe at 3 mm depth when HFUS measurements give depth lesion values smaller than this value.

No MeSH data available.


Related in: MedlinePlus

High frequency ultrasonography examples of depth measurement. A) Superficial basal cell carcinoma. B) Nodular basal cell carcinoma
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Figure 0003: High frequency ultrasonography examples of depth measurement. A) Superficial basal cell carcinoma. B) Nodular basal cell carcinoma

Mentions: After the biopsy, a radiologist who was an expert in skin lesions, estimated the depth of the lesions. All BCCs were scanned in vivo using a high resolution B-scan with an 18 MHz hand-held transducer (Siemens Acuson S2000, Munich, Germany). A 2 cm × 9 cm gel pad (Aquaflex, Pallejà, Barcelona, Spain) was applied over the skin to enhance the air-skin interface (Fig. 2). High frequencies have better resolution, but lower frequencies are often used in hospital, and it has been reported in the literature that there is a good correlation between ultrasonic and histologic measurements (with complete lesion excision), even with probes emitting frequencies of 15 MHz or lower [34]. In each lesion, the depth (from the epidermal surface to the deepest hypo-echoic point of the tumour) was measured. Because the epidermis thickness is approximately 0.1 mm, when HFUS did not show any value, 0.1 mm was assigned. Examples are given in Figure 3 for both superficial and nodular lesions.


Depth determination of skin cancers treated with superficial brachytherapy: ultrasound vs. histopathology.

Ballester-Sánchez R, Pons-Llanas O, Llavador-Ros M, Botella-Estrada R, Ballester-Cuñat A, Tormo-Micó A, Javier Celadá-Álvarez F, Rodríguez-Villalba S, Santos-Ortega M, Ballester-Pallarés F, Perez-Calatayud J - J Contemp Brachytherapy (2014)

High frequency ultrasonography examples of depth measurement. A) Superficial basal cell carcinoma. B) Nodular basal cell carcinoma
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4300362&req=5

Figure 0003: High frequency ultrasonography examples of depth measurement. A) Superficial basal cell carcinoma. B) Nodular basal cell carcinoma
Mentions: After the biopsy, a radiologist who was an expert in skin lesions, estimated the depth of the lesions. All BCCs were scanned in vivo using a high resolution B-scan with an 18 MHz hand-held transducer (Siemens Acuson S2000, Munich, Germany). A 2 cm × 9 cm gel pad (Aquaflex, Pallejà, Barcelona, Spain) was applied over the skin to enhance the air-skin interface (Fig. 2). High frequencies have better resolution, but lower frequencies are often used in hospital, and it has been reported in the literature that there is a good correlation between ultrasonic and histologic measurements (with complete lesion excision), even with probes emitting frequencies of 15 MHz or lower [34]. In each lesion, the depth (from the epidermal surface to the deepest hypo-echoic point of the tumour) was measured. Because the epidermis thickness is approximately 0.1 mm, when HFUS did not show any value, 0.1 mm was assigned. Examples are given in Figure 3 for both superficial and nodular lesions.

Bottom Line: Depth value differences with both modalities resulted patient dependent and then consequence of its uncertainty.According to the results, HFUS is less accurate at very shallow depths.In our clinical practice, we decided to prescribe at 3 mm depth when HFUS measurements give depth lesion values smaller than this value.

View Article: PubMed Central - PubMed

Affiliation: Dermatology Department, La Fe University and Polytechnic Hospital, Valencia.

ABSTRACT

Purpose: The purpose of this study is to compare high frequency ultrasonography (HFUS) and histpathologic assessment done by punch biopsy in order to determine depth of basal cell carcinoma (BCC), in both superficial and nodular BCCs prior to brachytherapy treatment.

Material and methods: This study includes 20 patients with 10 superficial and 10 nodular BCCs. First, punch biopsy was done to confirm the diagnosis and to measure tumour depth (Breslow rate). Subsequently, HFUS was done to measure tumour depth to search for correlation of these two techniques.

Results: Neither clear tendency nor significance of the punch biopsy vs. HFUS depth determination is observed. Depth value differences with both modalities resulted patient dependent and then consequence of its uncertainty. Conceptually, HFUS should determine the macroscopic lesion (gross tumour volume - GTV), while punch biopsy is able to detect the microscopic extension (clinical target volume - CTV). Uncertainties of HFUS are difficult to address, while punch biopsy is done just on a small lesion section, not necessarily the deepest one.

Conclusions: According to the results, HFUS is less accurate at very shallow depths. Nodular cases present higher depth determination differences than superficial ones. In our clinical practice, we decided to prescribe at 3 mm depth when HFUS measurements give depth lesion values smaller than this value.

No MeSH data available.


Related in: MedlinePlus