Ultrasound and fine-needle aspiration in dermatology, underuse of minimally invasive, efficient diagnostic tools

BACKGROUND Ultrasound imaging and ultrasound-guided fine-needle aspiration (FNA) are common procedures used to evaluate and sample cutaneous and subcutaneous tissue. Although ultrasound and FNA have been explored for individual neoplasms, lymph node involvement, and metastases, their use in day-to-day dermatology is not well defined. OBJECTIVE To investigate the use and utility of ultrasound and FNA in the dermatologic surgery division of a large academic institution. METHODS Retrospective case review of all ultrasound and FNA procedures ordered by a dermatologic surgeon over a 3-year period. RESULTS Metastatic disease was suspected in 11 of 21 (52.4%) cases. Cytology confirmed the presence of metastatic disease in two of the 11 cases, and metastatic disease was identified in one additional case in which the diagnosis was not suspected at clinical presentation. Cytology revealed leukemia or lymphoma in three (14.3%) cases, two of which were new diagnoses. Sonographic imaging and cytology revealed a benign diagnosis in 16 (76.2%) cases, five of which were reactive lymph nodes. CONCLUSIONS The results suggest that ultrasound and FNA are underused techniques that may play an important role in dermatology diagnostics and have the potential for expansion in day-to-day clinical practice.