Recommendations for the execution and reporting of skin ultrasound in systemic sclerosis: an international collaboration under the WSF skin ultrasound group

Abstract

ObjectiveUltrasound is a promising tool to foster much-needed improvement of skin assessment in systemic sclerosis (SSc). Our aim was to develop evidence and expert opinion-based recommendations to promote the standardisation and harmonisation of technical execution and reporting of skin ultrasound studies in SSc.MethodsA multidisciplinary task force of 16 members from five European countries and Japan was convened under the auspices of World Scleroderma Foundation. First, a systematic literature review (SLR) was performed. Then, each member proposed and formulated items to the overarching principles, recommendations and research agenda. Two rounds of mails exchange for consensus as well as an on-line meeting were performed to debate and refine the proposals. Two Delphi rounds of voting resulted in the final recommendations. Levels of evidence and strengths of recommendations were assigned, and task force members voted anonymously on the level of agreement with each of the items.ResultsFive overarching principles and seven recommendations were developed, based on an SLR and expert opinion, through consensus procedures. The overarching principles highlight the promising role of skin ultrasound in SSc assessment, the need for standardisation of technical aspects, sufficient training and adequate equipment. The recommendations provide standards for the execution and reporting of skin ultrasound in SSc. The research agenda includes the need for more research into unmet needs according to Outcome Measures in Rheumatology Algorithm requirements.ConclusionThese are the first recommendations providing guidance on the execution and reporting of skin ultrasound in SSc patients, aiming at improving the interpretability, reliability and generalisability of skin ultrasound, thus consolidating its role in research and practice.

Skin ultrasound in systemic sclerosis: past, present and exciting future

“…Over the past four decades, US has attracted considerable interest as a tool to evaluate skin involvement in SSc patients and overcome the limitations of the mRSS. Both B-mode and shear-wave elastography US have several advantages: wide availability (at least B-mode); easy training; safe and non-invasive imaging procedures; immediate provision of results to clinicians; allowing the examination of multiple skin sites in a single session; and ability to store collected images [ 4 ]. Other potential advantages of US assessment include the continuous nature of the data, which might overcome the limited ability of the mRSS to identify subtle, but clinically important, changes.…”

“…Also, B-mode US might allow for earlier detection of skin involvement, as suggested by positive findings in apparently unaffected skin areas. Despite all these promising results, the real value of B-mode US and elastography as a correlate or surrogate of skin involvement in SSc has remained unclear, owing a number of methodological caveats and persistent knowledge gaps [ 4 , 5 ].…”

“…Based on the previous review results and expert opinion, an international group under the auspices of World Scleroderma Foundation published recommendations for the execution and reporting of skin US studies to promote standardization and harmonization of US technical procedures [ 4 ]. Importantly, two relevant works included in the systematic literature review shed light in the construct validity of US-dermal thickness and skin stiffness against skin histological findings [ 4 ].These studies used forearm skin biopsies and found moderate to good correlations between skin thickness measured by US and histological findings. However, no clear correlation could be established between histological skin thickness and US skin stiffness [ 4 ].…”

“…Importantly, two relevant works included in the systematic literature review shed light in the construct validity of US-dermal thickness and skin stiffness against skin histological findings [ 4 ].These studies used forearm skin biopsies and found moderate to good correlations between skin thickness measured by US and histological findings. However, no clear correlation could be established between histological skin thickness and US skin stiffness [ 4 ]. In one study, both US stiffness and local mRSS were strongly correlated with histological dermal collagen content [ 4 ].…”

“…However, no clear correlation could be established between histological skin thickness and US skin stiffness [ 4 ]. In one study, both US stiffness and local mRSS were strongly correlated with histological dermal collagen content [ 4 ].…”