Background:The similar visual appearance of high-risk basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC) may cause confusion for diagnosis.High-frequency ultrasound (HFUS) may provide additional intralesional information and thus help to distinguish them. Method:In this retrospective study, we analyzed the clinical characteristics, HFUS grayscale, and color Doppler flow imaging (CDFI) features of pathologically confirmed high-risk BCC and cSCC lesions (n = 65 vs n = 68). Subsequently, discrimination models based on the significant HFUS features were established. Results:Between high-risk BCC and cSCC lesions, the HFUS grayscale features of the lesion size (10.0 mm vs 17.4 mm), thickness (3.1 mm vs 5.9 mm), internal hyperechoic spots (80.0% vs 23.5%), and posterior acoustic shadowing (16.9% vs 66.2%) were statistically different (all p < 0.001). As for the CDFI features, high-risk BCC lesions mainly appeared as pattern II (47.7%), while cSCC lesions mainly appeared as pattern III (66.2%). Based on the above five features, an optimal discrimination model was established with a sensitivity of 91.2%, a specificity of 87.7%, and an accuracy of 89.5%. Conclusion:HFUS features, including size, thickness, internal hyperechoic spots, posterior acoustic shadowing, and Doppler vascularity pattern, are useful for differential diagnosis between high-risk BCC and cSCC.
Purpose: To investigate the value of synchronous teleultrasound (TUS) for the naive operator in thyroid US examination.Methods: 97 patients comprised this prospective, parallel controlled trial. Thyroid scanning and diagnosis were completed in turn by resident A independently, resident B instructed by an US expert through synchronous TUS, and an on-site US expert.Findings of the on-site expert were used as the reference standard. Two other off-site US experts analyzed all the data in a blind manner. Inter-operator consistency between the two residents and on-site US expert for thyroid size measurement, nodule measurement, nodule feature, ACR TI-RADS categories, and image quality was compared, respectively. Two different questionnaires were completed to evaluate the clinical benefit. Results:Resident B detected more nodules consistent with the on-site expert than resident A did (89.4% vs. 54.2%; P < 0.001). Resident B achieved excellent consistency with on-site expert in terms of ACR TI-RADS categories, nodule composition, shape, echogenic foci, and vascularity (all ICC > 0.75), while resident A achieved lower consistency in ACR TI-RADS categories, composition, echogenicity, margin, echogenic foci, and vascularity (all ICC in 0.40 -0.75) of nodule features.Resident A and resident B had excellent consistency in the measurements of target nodule (all ICC > 0.75). In terms of gray value, time gain compensation, depth, color Doppler adjustment, and the visibility of key information, resident B achieved better performance than resident A did (all P < 0.05). 61.9% (60/97) patients accepted the synchronous TUS, and 59.8% (58/97) patients were willing to pay for it. Conclusion:Synchronous TUS can help the inexperienced US resident to achieve the diagnostic capability at a similar level of US expert in thyroid scanning with high
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