Ultrasound and elastography in the assessment of skin involvement in systemic sclerosis: A systematic literature review focusing on validation and standardization – WSF Skin Ultrasound Group

Santiago, Tânia; Santos, Eduardo; Ruaro, Barbara; Lepri, Gemma; Green, Lorraine; Wildt, Marie; Watanabe, Shinji; Lescoat, Alain; Hesselstrand, Roger; Galdo, Francesco Del; Pauling, John D; Iagnocco, Annamaria; Silva, JAP da

doi:10.1016/j.semarthrit.2022.151954

Cited by 15 publications

(76 citation statements)

References 62 publications

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“…The integration of skin ultrasound into SSc clinical trials and daily practice and the full fruition of this technique’s potential demands the fulfilment of the OMERACT filter requirements, as highlighted in our previous SLR 9. Ultrasound thickness and stiffness have already demonstrated robust evidence for convergent validity against the ‘gold standard’ and skin histological findings19 20 and good to excellent intrareliability and inter-reliability.…”

Section: Resultsmentioning

confidence: 99%

“…Item R6 (a) demands a clear description of the quality criteria used to accept each of the ultrasound images. The task force considers that B-mode images should only be accepted for analysis if an adequate depiction of epidermis, dermis and subcutis, with distinct and parallel interfaces between them is achieved 9. In the case of elastography, the majority of softwares provides an automated image quality factor to allow clinicians to select the highest quality image 15.…”

Section: Resultsmentioning

confidence: 99%

“…Recommendation 1: The examination of the skin in SSc patients should, whenever possible, include B-mode ultrasound, to measure thickness and echogenicity, and also elastography to measure stiffness Based on the evidence found in the SLR, 9 the task force considers it crucial to push research in all these three ultrasound domains to obtain further insights into its OMERACT measurement properties. Simultaneous ultrasound evaluation of skin thickness, stiffness and echogenicity may help to clarify the underlying pathological conditions and the relationship between these ultrasound features, a knowledge gap which is highlighted in the research agenda (table 2).…”

Section: Recommendations Section A: Recommendations For the Execution...mentioning

confidence: 99%

“…The use of ultrasound for skin assessment in SSc has been extensively investigated over the last four decades 7 8. Ultrasound may have some advantages over mRSS,7–9 including its higher intrarater and inter-rater reproducibility and sensitivity to change 10. Moreover, high-frequency ultrasound can identify early subclinical skin involvement in areas with a normal mRSS 11 12.…”

Section: Introductionmentioning

confidence: 99%

“…A recent systematic literature review (SLR) has summarised all available evidence on the use of ultrasound and elastography to assess skin involvement in SSc, according to the Outcome Measures in Rheumatology (OMERACT) filter selection algorithm (OFISA). 9 This review identified significant knowledge gaps in the three pillars of evidence: truth, discrimination and feasibility. For different reasons, none of the ultrasound domains (ie, thickness, echogenicity, stiffness) fully satisfied the OMERACT criteria.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Recommendations Section A: Recommendations For the Execution...mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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Assessment of the skin with 2D‐shear wave elastography in the systemic scleroderma and its correlation with pulmonary involvement

Tanyeri

Çildağ

2023

J of Clinical Ultrasound

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PurposeThe purpose of this study was to assess the skin involvement in systemic scleroderma patients (SSc) with 2D‐Shear Wave Elastography (2D‐SWE) and to review the corelation between skin elasticity and pulmonary involvement.MethodsThirty SSc patients and 30 controls were examined using 2D‐SWE. The demographics matched both groups. B‐mode ultrasound (US) and 2D‐SWE assessed skin thickness and elastography from the ventral side of the right forearm in each subjective. ROC analysis determined optimal group separation cut‐off values. A rheumatologist applied mRSS for SSc patients. US, mRSS, and pulmonary involvement correlations were reviewed.ResultsUS parameter values (skin thickness, median kPa, median m/s) were higher in the SSc patient group (1.78 ± 0.36 mm, 22.15 ± 16.26, 2.60 ± 0.82, respectively) compared to the control group (1.55 ± 0.2 mm, 7.45 ± 1.84, 1.56 ± 0.2, respectively, p < 0.05). When the optimal cut‐off SWE values for separating groups was determined as 10.5 kPa and 1.87 m/s, the sensitivity was 93% and the specificity was 97%. Pearson's correlation analysis showed a strong positive correlation between mRSS and median SWE values (kPa, r = 0.626, p = 0.001; m/s, r = 0.638, p < 0.001). There was no correlation between pulmonary involvement of SSc patients with mRSS and US parameters.Conclusion2D‐SWE is a promising non‐invasive method to evaluate skin involvement in SSc patient group. For pulmonary involvement we need more data with bigger patient groups.

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High frequency ultrasound assessment of skin in systemic sclerosis patients

Gabal

Mohamed

Moawed

et al. 2023

The Egyptian Rheumatologist

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Ultrasound and elastography in the assessment of skin involvement in systemic sclerosis: A systematic literature review focusing on validation and standardization – WSF Skin Ultrasound Group

Cited by 15 publications

References 62 publications

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

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

Assessment of the skin with 2D‐shear wave elastography in the systemic scleroderma and its correlation with pulmonary involvement

High frequency ultrasound assessment of skin in systemic sclerosis patients

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