title: Ultrasound as predictor of histologic subtypes linked to recurrence in basal cell carcinoma of the skin.
abstract: BACKGROUND
  Basal cell carcinoma (BCC) recurrences, especially in the facial region, represent a complex cosmetic problem. To date the possibility of predicting recurrence is supported solely by the histologic subtype.
  
  
  OBJECTIVE
  To evaluate the relationship between BCC histologic subtypes linked to high and low risk of recurrence and the presence of hyperechoic spots on sonography.
  
  
  METHODS
  Retrospective analysis of the pre-surgical ultrasound examinations of primary BCC tumours with visualization and counting of intra-tumoural hyperechoic spots. The data were then correlated with the corresponding histologic subtype.
  
  
  RESULTS
  Thirty one patients with histologically proven BCC were included in the study. Hyperechoic spots were detected in all cases and there was a positive, statistically significant association between hyperechoic spots count and high recurrence risk histologic subtypes. Higher hyperechoic spots count was found in the recurrence-prone micronodular, sclerosing variant and morpheiform BCC subtypes. Low risk and high risk of recurrence showed a significant difference on the mean hyperechoic spots count of 5.5 (range: 3-25) and 8 (4-81). A cut-off point ≥7 hyperechoic spots presented a sensitivity of 79% and specificity of 53% for predicting the high risk of recurrence subtypes.
  
  
  CONCLUSIONS
  The presence and count of hyperechoic spots within BCC lesions may help predicting the high risk of recurrence histologic subtypes.
authors.affiliation: Departments of Radiology and Dermatology, IDIEP, Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Clinica Servet, Faculty of Medicine, University of Chile, Santiago, Chile.
authors.forename: X
authors.initials: X
authors.lastname: Wortsman
authors.forename: P
authors.initials: P
authors.lastname: Vergara
authors.forename: A
authors.initials: A
authors.lastname: Castro
authors.forename: D
authors.initials: D
authors.lastname: Saavedra
authors.forename: F
authors.initials: F
authors.lastname: Bobadilla
authors.forename: I
authors.initials: I
authors.lastname: Sazunic
authors.forename: V
authors.initials: V
authors.lastname: Zemelman
authors.forename: J
authors.initials: J
authors.lastname: Wortsman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002280:Basal Cell Carcinoma / Q000000981:diagnostic imaging* / Q000473:pathology; D005153:Facial Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012535:Scalp; D012878:Skin Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D014463:Ultrasonography