Test characteristics of high-resolution ultrasound in the preoperative assessment of margins of basal cell and squamous cell carcinoma in patients undergoing mohs micrographic surgery

Anokhi Jambusaria-Pahlajani, Chrysalyne D. Schmults, Christopher J. Miller, Daniel Shin, Jennifer Williams, Shanu K. Kurd, Joel M. Gelfand

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

BACKGROUND: Noninvasive techniques to assess subclinical spread of nonmelanoma skin cancer (NMSC) may improve surgical precision. High-resolution ultrasound has shown promise in evaluating the extent of NMSC. OBJECTIVES: To determine the accuracy of high-resolution ultrasound to assess the margins of basal cell (BCC) and squamous cell carcinomas (SCC) before Mohs micrographic surgery (MMS). METHODS: We enrolled 100 patients with invasive SCC or BCC. Before the first stage of MMS, a Mohs surgeon delineated the intended surgical margin. Subsequently, a trained ultrasound technologist independently evaluated disease extent using the EPISCAN I-200 to evaluate tumor extent beyond this margin. The accuracy of high-resolution ultrasound was subsequently tested by comparison with pathology from frozen sections. RESULTS: The test characteristics of the high-resolution ultrasound were sensitivity=32%, specificity=88%, positive predictive value=47%, and negative predictive value=79%. Subgroup analyses demonstrated better test characteristics for tumors larger than the median (area>1.74 cm2). Qualitative analyses showed that high-resolution ultrasound was less likely to identify extension from tumors with subtle areas of extension, such as small foci of dermal invasion from infiltrative SCC and micronodular BCC. CONCLUSION: High-resolution ultrasound requires additional refinements to improve the preoperative determination of tumor extent before surgical treatment of NMSC.

Original languageEnglish (US)
Pages (from-to)9-15
Number of pages7
JournalDermatologic Surgery
Volume35
Issue number1
DOIs
StatePublished - Jan 2009
Externally publishedYes

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Mohs Surgery
Squamous Cell Carcinoma
Skin Neoplasms
Neoplasms
Frozen Sections
Pathology
Sensitivity and Specificity
Skin

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)
  • Dermatology

Cite this

Test characteristics of high-resolution ultrasound in the preoperative assessment of margins of basal cell and squamous cell carcinoma in patients undergoing mohs micrographic surgery. / Jambusaria-Pahlajani, Anokhi; Schmults, Chrysalyne D.; Miller, Christopher J.; Shin, Daniel; Williams, Jennifer; Kurd, Shanu K.; Gelfand, Joel M.

In: Dermatologic Surgery, Vol. 35, No. 1, 01.2009, p. 9-15.

Research output: Contribution to journalArticle

Jambusaria-Pahlajani, Anokhi ; Schmults, Chrysalyne D. ; Miller, Christopher J. ; Shin, Daniel ; Williams, Jennifer ; Kurd, Shanu K. ; Gelfand, Joel M. / Test characteristics of high-resolution ultrasound in the preoperative assessment of margins of basal cell and squamous cell carcinoma in patients undergoing mohs micrographic surgery. In: Dermatologic Surgery. 2009 ; Vol. 35, No. 1. pp. 9-15.
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abstract = "BACKGROUND: Noninvasive techniques to assess subclinical spread of nonmelanoma skin cancer (NMSC) may improve surgical precision. High-resolution ultrasound has shown promise in evaluating the extent of NMSC. OBJECTIVES: To determine the accuracy of high-resolution ultrasound to assess the margins of basal cell (BCC) and squamous cell carcinomas (SCC) before Mohs micrographic surgery (MMS). METHODS: We enrolled 100 patients with invasive SCC or BCC. Before the first stage of MMS, a Mohs surgeon delineated the intended surgical margin. Subsequently, a trained ultrasound technologist independently evaluated disease extent using the EPISCAN I-200 to evaluate tumor extent beyond this margin. The accuracy of high-resolution ultrasound was subsequently tested by comparison with pathology from frozen sections. RESULTS: The test characteristics of the high-resolution ultrasound were sensitivity=32{\%}, specificity=88{\%}, positive predictive value=47{\%}, and negative predictive value=79{\%}. Subgroup analyses demonstrated better test characteristics for tumors larger than the median (area>1.74 cm2). Qualitative analyses showed that high-resolution ultrasound was less likely to identify extension from tumors with subtle areas of extension, such as small foci of dermal invasion from infiltrative SCC and micronodular BCC. CONCLUSION: High-resolution ultrasound requires additional refinements to improve the preoperative determination of tumor extent before surgical treatment of NMSC.",
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AU - Williams, Jennifer

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