title: Usefulness of High-Frequency Ultrasound in the Classification of Histologic Subtypes of Primary Basal Cell Carcinoma.
abstract: BACKGROUND
  Incisional biopsy may not always provide a correct classification of histologic subtypes of basal cell carcinoma (BCC). High-frequency ultrasound (HFUS) imaging of the skin is useful for the diagnosis and management of this tumor.
  
  
  OBJECTIVE
  The main aim of this study was to compare the diagnostic value of HFUS compared with punch biopsy for the correct classification of histologic subtypes of primary BCC. We also analyzed the influence of tumor size and histologic subtype (single subtype vs. mixed) on the diagnostic yield of HFUS and punch biopsy.
  
  
  METHODS
  Retrospective observational study of primary BCCs treated by the Dermatology Department of Hospital Costa del Sol in Marbella, Spain, between october 2013 and may 2014. Surgical excision was preceded by HFUS imaging (Dermascan C©, 20-MHz linear probe) and a punch biopsy in all cases. We compared the overall diagnostic yield and accuracy (sensitivity, specificity, positive predictive value [PPV], and negative predictive value [NPV]) of HFUS and punch biopsy against the gold standard (excisional biopsy with serial sections) for overall and subgroup results.
  
  
  RESULTS
  We studied 156 cases. The overall diagnostic yield was 73.7% for HFUS (sensitivity, 74.5%; specificity, 73%) and 79.9% for punch biopsy (sensitivity, 76%; specificity, 82%). In the subgroup analyses, HFUS had a PPV of 93.3% for superficial BCC (vs. 92% for punch biopsy). In the analysis by tumor size, HFUS achieved an overall diagnostic yield of 70.4% for tumors measuring 40mm2or less and 77.3% for larger tumors; the NPV was 82% in both size groups. Punch biopsy performed better in the diagnosis of small lesions (overall diagnostic yield of 86.4% for lesions ≤40mm2vs. 72.6% for lesions >40mm2).
  
  
  CONCLUSIONS
  HFUS imaging was particularly useful for ruling out infiltrating BCCs, diagnosing simple, superficial BCCs, and correctly classifying BCCs larger than 40mm2.
authors.affiliation: Servicios de Dermatología y Venereología, Hospital Costa del Sol, Marbella, Málaga, España. Electronic address: chernandez@aedv.es.
authors.forename: C
authors.initials: C
authors.lastname: Hernández-Ibáñez
authors.affiliation: Servicios de Dermatología y Venereología, Hospital Costa del Sol, Marbella, Málaga, España.
authors.forename: N
authors.initials: N
authors.lastname: Blazquez-Sánchez
authors.affiliation: Servicios de Dermatología y Venereología, Hospital Costa del Sol, Marbella, Málaga, España.
authors.forename: M
authors.initials: M
authors.lastname: Aguilar-Bernier
authors.affiliation: Servicio de Anatomía Patológica, Hospital Costa del Sol, Marbella, Málaga, España.
authors.forename: R
authors.initials: R
authors.lastname: Fúnez-Liébana
authors.affiliation: Unidad de Investigación, Hospital Costa del Sol, Marbella, Málaga, España.
authors.forename: F
authors.initials: F
authors.lastname: Rivas-Ruiz
authors.affiliation: Servicios de Dermatología y Venereología, Hospital Costa del Sol, Marbella, Málaga, España.
authors.forename: M
authors.initials: M
authors.lastname: de Troya-Martín
mesh_terms: D000368:Aged; D001706:Biopsy / Q000379:methods; D002280:Basal Cell Carcinoma / Q000145:classification / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012878:Skin Neoplasms / Q000145:classification / Q000000981:diagnostic imaging* / Q000473:pathology; D014463:Ultrasonography / Q000379:methods*
keywords: Basal cell carcinoma; Carcinoma basocelular; Ecografía; Ultrasound