Value of High‐Frequency Ultrasound in Accurate Staging of Mycosis Fungoides/Sézary Syndrome

Abstract

Objectives-This study was aimed to assess the ultrasound (US) characteristics of mycosis fungoides (MF)/Sézary syndrome (SS) and explore the value of high-frequency US in accuracy staging for classic mycosis fungoides (cMF). Methods-A prospective study was designed. Twenty-six patients with histopathologically confirmed MF or SS were enrolled to undergo HF-US examinations. Both 50-and 20-MHz US images of the most prominent lesion of each patient were collected by a cutaneous diagnostic US system, and the US characteristics in different stages were analyzed by 2 physicians independently. The Fisher exact test was used for the statistical analysis. Results-A total of 26 patients underwent this study, including 23 with cMF, 2 with folliculotropic mycosis fungoides (FMF), and 1 with SS. Among cMF, 16 patients with patches or plaques (the early-stage group) showed a subepidermal low-echogenic band, and only 3 lesions in the plaque stage partially extended to the superficial dermis. Seven patients with tumors (the advancedstage group) showed lesions that infiltrated to the deep dermis or subcutaneous tissue. The infiltration depth (P < .001), clarity of the boundary (P = .002), and homogeneity of internal echoes (P = .001) were significantly different between the early and advanced stages. Additionally, the 2 FMF lesions and 1 SS lesion had characteristic manifestations, showing a well-defined subepidermal lowechogenic band with patchy hypoechoic regions around the hair follicles in the dermis. Conclusions-High-frequency US can be used to accurately detect the infiltration depth and morphologic features of MF/SS lesions and provide important information for tumor staging of cMF. Additionally, the characteristic US features in FMF and SS might be helpful for diagnosis. Key Words-cutaneous lymphoma; high-frequency ultrasound; mycosis fungoides; Sézary syndrome M ycosis fungoides (MF) and Sézary syndrome (SS) are typical types of cutaneous T-cell lymphoma (CTCL). Mycosis fungoides and its variants are the most common types of CTCL, approximately accounting for 60% of cases. On clinical assessment, classic mycosis fungoides (cMF) lesions can be classified into patch, plaque, and tumor stages. Patients with SS commonly have rapidly progressing erythroderma with generalized lymphadenopathy. Accurate staging is an important prerequisite for individualized treatment of patients with MF. At present, skin lesions are classified into different stages mainly through inspection and

The value of high‐frequency ultrasonography in the differential diagnosis of early mycosis fungoides and inflammatory skin diseases: A case‐control study

“…Previous studies have reported SLEB as a typical ultrasonic characteristic in photoaging skin 8 . But with the application of HF‐US in more and more skin lesions, SLEB is not a specific ultrasonic feature and can be found in atopic dermatitis and MF, and is considered to be caused by edema or infiltration of inflammatory cells 3,6,7,9‐13 . The study of Polanska et al showed a significant correlation between the depth of lymphocytes infiltration in histopathology and thickness of SLEB in plaque psoriasis, 17 and the SLEB narrowed or disappeared after treatment, which showed the better correlation between the HF‐US and pathology.…”

“…The ultrasound characteristics of the lesions were independently evaluated by 2 senior sonographers, and they reached an agreement by discussion when the results were inconsistent. Based upon the previous reports, 1‐13 the assessment of the ultrasound images included evaluation of epidermal morphology (even or uneven), infiltration depth (the deepest layer of the skin that the lesion infiltrated), subepidermal low echogenic band (SLEB) boundary (clearly or unclearly identified from the underlying skin structures), SLEB internal echo (homogeneous or inhomogeneous), epidermis thickness (the vertical distances of the thickest parts of epidermis), SLEB thickness (the vertical distances of the thickest parts of SLEB) (Figures 2 and 3), and number of linear acoustic shadows behind the epidermis in the same section (the vertical low echogenic band behind the epidermis) (Figure 4).…”

Biophysical and ultrasonographic changes in early patch/plaque stage of mycosis fungoides, compared with uninvolved skin

“…Decrease in lesional dermal density in lichen planus, psoriasis, and dermatitis has been seen previously, but there were significant differences in three diseases considering the amount of this decrease. 19 The results of Niu's study also showed that HFUS could help in identification of early-stage MF (eMF), psoriasis vulgaris [21][22][23] Parapsoriasis/MF biophysical and ultrasonographic changes in decision tree models to differentiate with other papulosquamous skin disorders have shown that the most possible confusion was related to differentiation between parapsoriasis/MF and pityriasis rosea and the amount of increase in skin erythema was decisive to differentiate them. The lesions of pityriasis rosea tend to be more erythematous clinically too, while the erythema in parapsoriasis/MF lesions is lower.…”

High‐frequency ultrasound features in vulvar lichen sclerosus and correlation with histopathology

“…A significant consistency between the thickness of hypoechoic dermal band and the depth of histopathological infiltration was also found in cutaneous malignancies such as mycosis fungoides. 12,14 Therefore, we speculate that HFUS would also be a reproducible and effective noninvasive tool for the assessment of VLS.…”