The accuracy of elastographic strain ratio and ultrasound thickness in the differentiation of thin and thick cutaneous melanoma

Abstract

Background Cutaneous melanoma is the most deadly of skin neoplasms. Few studies have investigated the role of elastography characteristics so the ability of elastography in the differentiation of thin and thick cutaneous melanoma is still narrow. Purpose To investigate the accuracy of elastography in differentiating thin and thick melanoma, by measuring strain ratio (SR) between the lesion and adjacent dermis and hypodermis. Material and Methods We investigated by ultrasound and elastography 52 melanoma lesions in 49 patients. The receiver operating characteristic (ROC) curve method was used to investigate the accuracy of ultrasound and elastographic measurement of SR to surrounding tissue, in the differentiation of thin and thick melanomas. The histopathological measurement of lesions depth called Breslow index was the golden standard test. Results Areas under the curve (AUC) showed low accuracy for SR to hypodermis in distinguishing between thin melanomas and others (AUC = 0.739, 95% confidence interval [CI] = 0.508–0.970]) with a cut-off value of 0.950, being the only statistically significant result in matter of elastographic measurements. Highly statistically significant results were obtained for B-mode ultrasound depth measurements of the lesion, with an AUC = 0.970 (95% CI = 0.927–1.0) in discriminating thin melanomas of others and 0.951 (95% CI = 0.869–1.0) in discriminating thick melanomas of other types. Conclusion Despite the appearance that SR may correlate with the depth of the lesion, elastography, by measuring the SRs to dermis and hypodermis, does not have enough accuracy in distinguishing thin and thick melanoma.

Interventional Ultrasound in Dermatology: A Pictorial Overview Focusing on Cutaneous Melanoma Patients

“…8 However, measuring the strain ratio has not proven sufficiently accurate in distinguishing thin and thick melanoma. 7,8 Fine-Needle Aspiration Cytology Fine-needle aspiration cytology (FNAC) can be employed for assess superficial lesions suspected to be melanoma metastases (Figure 4) or US-abnormal Corvino et al-Cutaneous Melanoma: Ultrasound-Guided Intervention regional lymph nodes, ruling out or confirming melanoma involvement (Figure 5).…”

“…Power‐ and color‐Doppler scanning is always included, provided that the scanner is set adequately to detect slow flows 3 . Elastography has not entered the practice of skin US yet, but the preliminary scientific results are quite encouraging 7–10 . Qualitative and quantitative assessment with elastography may be of interest for the differential diagnostic assessment of melanocytic skin tumors 8 .…”

“…Qualitative and quantitative assessment with elastography may be of interest for the differential diagnostic assessment of melanocytic skin tumors 8 . However, measuring the strain ratio has not proven sufficiently accurate in distinguishing thin and thick melanoma 7,8 …”

“… 3 Elastography has not entered the practice of skin US yet, but the preliminary scientific results are quite encouraging. 7 , 8 , 9 , 10 Qualitative and quantitative assessment with elastography may be of interest for the differential diagnostic assessment of melanocytic skin tumors. 8 However, measuring the strain ratio has not proven sufficiently accurate in distinguishing thin and thick melanoma.…”

“… 8 However, measuring the strain ratio has not proven sufficiently accurate in distinguishing thin and thick melanoma. 7 , 8 …”