Korean Journal of Radiology

  • 제20권10호
  • /
  • Pages.1409-1421
  • /
  • 2019
  • /
  • 1229-6929(pISSN)
  • /
  • 2005-8330(eISSN)
대한영상의학회 (The Korean Society of Radiology)
권호 표지
DOI QR코드

DOI QR Code

Ultrasound Feature-Based Diagnostic Model Focusing on the "Submarine Sign" for Epidermal Cysts among Superficial Soft Tissue Lesions

  • Lee, Da Hyun (Department of Radiology, Gangnam Severance Hospital, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Yonsei University College of Medicine) ;
  • Yoon, Choon-Sik (Department of Radiology, Gangnam Severance Hospital, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Yonsei University College of Medicine) ;
  • Lim, Beom Jin (Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Lee, Hye Sun (Biostatistics Collaboration Unit, Yonsei University College of Medicine) ;
  • Kim, Sinae (Biostatistics Collaboration Unit, Yonsei University College of Medicine) ;
  • Choi, A Lam (Department of Radiology, Gangnam Severance Hospital, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Yonsei University College of Medicine) ;
  • Kim, Sungjun (Department of Radiology, Gangnam Severance Hospital, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Yonsei University College of Medicine)
  • 투고 : 2019.04.03
  • 심사 : 2019.07.23
  • 발행 : 2019.10.01
⟨ 이전 논문 다음 논문 ⟩

초록

Objective: To develop a diagnostic model for superficial soft tissue lesions to differentiate epidermal cyst (EC) from other lesions based on ultrasound (US) features. Materials and Methods: This retrospective study included 205 patients who had undergone US examinations for superficial soft tissue lesions and subsequent surgical excision. The study population was divided into the derivation set (n = 112) and validation set (n = 93) according to the imaging date. The following US features were analyzed to determine those that could discriminate EC from other lesions: more-than-half-depth involvement of the dermal layer, "submarine sign" (focal projection of the hypoechoic portion to the epidermis), posterior acoustic enhancement, posterior wall enhancement, morphology, shape, echogenicity, vascularity, and perilesional fat change. Using multivariable logistic regression, a diagnostic model was constructed and visualized as a nomogram. The performance of the diagnostic model was assessed by calculating the area under the curve (AUC) of the receiver operating characteristic curve and calibration plot in both the derivation and validation sets. Results: More-than-half-depth involvement of the dermal layer (odds ratio [OR] = 3.35; p = 0.051), "submarine sign" (OR = 12.2; p < 0.001), and morphology (OR = 5.44; p = 0.002) were features that outweighed the others when diagnosing EC. The diagnostic model based on these features showed good discrimination ability in both the derivation set (AUC = 0.888, 95% confidence interval [95% CI] = 0.825-0.950) and validation set (AUC = 0.902, 95% CI = 0.832-0.972). Conclusion: More-than-half-depth of involvement of the dermal layer, "submarine sign," and morphology are relatively better US features than the others for diagnosing EC.

키워드

과제정보

This study was supported by the National Research Foundation of Korea (NRF) grant funded by the MIST (Ministry of Science and ICT) of Korean government (2017R1A2B2011366).

참고문헌

  1. Vincent LM, Parker LA, Mittelstaedt CA. Sonographic appearance of an epidermal inclusion cyst. J Ultrasound Med 1985;4:609-611 https://doi.org/10.7863/jum.1985.4.11.609
  2. Lee HS, Joo KB, Song HT, Kim YS, Park DW, Park CK, et al. Relationship between sonographic and pathologic findings in epidermal inclusion cysts. J Clin Ultrasound 2001;29:374-383 https://doi.org/10.1002/jcu.1052
  3. Kim HK, Kim SM, Lee SH, Racadio JM, Shin MJ. Subcutaneous epidermal inclusion cysts: ultrasound (US) and MR imaging findings. Skeletal Radiol 2011;40:1415-1419 https://doi.org/10.1007/s00256-010-1072-4
  4. Stone MS. Cysts. In: Bolognia JL, Schaffer JV, Cerroni L, eds. Dermatology, 4th ed. New York, NY: Elsevier, 2018:1917-1929
  5. Benign neoplasms and hyperplasias. In: Wolff K, Johnson RA, Saavedra AP, Roh EK, eds. Fitzpatrick's color atlas and synopsis of clinical dermatology, 8th ed. New York, NY: McGraw-Hill Education, 2017:141-173
  6. Lopez-Rios F, Rodriguez-Peralto JL, Castano E, Benito A. Squamous cell carcinoma arising in a cutaneous epidermal cyst: case report and literature review. Am J Dermatopathol 1999;21:174-177 https://doi.org/10.1097/00000372-199904000-00012
  7. Veenstra JJ, Choudhry S, Krajenta RJ, Eide MJ. Squamous cell carcinoma originating from cutaneous cysts: the Henry Ford experience and review of the literature. J Dermatolog Treat 2016;27:95-98 https://doi.org/10.3109/09546634.2015.1054779
  8. Anton-Badiola I, San Miguel-Fraile P, Peteiro-Cancelo A, Ortiz-Rey JA. [Squamous cell carcinoma arising on an epidermal inclusion cyst: a case presentation and review of the literature]. Actas Dermosifiliogr 2010;101:349-353 https://doi.org/10.1016/j.ad.2010.01.001
  9. Hwang EJ, Yoon HS, Cho S, Park HS. The diagnostic value of ultrasonography with 5-15-MHz probes in benign subcutaneous lesions. Int J Dermatol 2015;54:e469-e475
  10. Hung EH, Griffith JF, Ng AW, Lee RK, Lau DT, Leung JC. Ultrasound of musculoskeletal soft-tissue tumors superficial to the investing fascia. AJR Am J Roentgenol 2014;202:W532-W540
  11. Nigam JS, Bharti JN, Nair V, Gargade CB, Deshpande AH, Dey B, et al. Epidermal cysts: a clinicopathological analysis with emphasis on unusual findings. Int J Trichology 2017;9:108-112 https://doi.org/10.4103/ijt.ijt_16_17
  12. Apollos JR, Ekatah GE, Ng GS, McFadyen AK, Whitelaw SC. Routine histological examination of epidermoid cysts; to send or not to send? Ann Med Surg (Lond) 2016;13:24-28
  13. Kuwano Y, Ishizaki K, Watanabe R, Nanko H. Efficacy of diagnostic ultrasonography of lipomas, epidermal cysts, and ganglions. Arch Dermatol 2009;145:761-764
  14. Wortsman X. Common applications of dermatologic sonography. J Ultrasound Med 2012;31:97-111 https://doi.org/10.7863/jum.2012.31.1.97
  15. Wortsman X, Wortsman J. Clinical usefulness of variable-frequency ultrasound in localized lesions of the skin. J Am Acad Dermatol 2010;62:247-256 https://doi.org/10.1016/j.jaad.2009.06.016
  16. Kleinerman R, Whang TB, Bard RL, Marmur ES. Ultrasound in dermatology: principles and applications. J Am Acad Dermatol 2012;67:478-487 https://doi.org/10.1016/j.jaad.2011.12.016
  17. Toprak H, Kilic E, Serter A, Kocakoc E, Ozgocmen S. Ultrasound and Doppler US in evaluation of superficial softtissue lesions. J Clin Imaging Sci 2014;4:12 https://doi.org/10.4103/2156-7514.127965
  18. Fornage BD, Tassin GB. Sonographic appearances of superficial soft tissue lipomas. J Clin Ultrasound 1991;19:215-220 https://doi.org/10.1002/jcu.1870190405
  19. Inampudi P, Jacobson JA, Fessell DP, Carlos RC, Patel SV, Delaney-Sathy LO, et al. Soft-tissue lipomas: accuracy of sonography in diagnosis with pathologic correlation. Radiology 2004;233:763-767 https://doi.org/10.1148/radiol.2333031410
  20. Lee MH, Kim NR, Ryu JA. Cyst-like solid tumors of the musculoskeletal system: an analysis of ultrasound findings. Skeletal Radiol 2010;39:981-986 https://doi.org/10.1007/s00256-010-0902-8
  21. Teefey SA, Dahiya N, Middleton WD, Gelberman RH, Boyer MI. Ganglia of the hand and wrist: a sonographic analysis. AJR Am J Roentgenol 2008;191:716-720 https://doi.org/10.2214/AJR.07.3438
  22. Feldman MK, Katyal S, Blackwood MS. US artifacts. Radiographics 2009;29:1179-1189 https://doi.org/10.1148/rg.294085199
  23. Huang CC, Ko SF, Huang HY, Ng SH, Lee TY, Lee YW, et al. Epidermal cysts in the superficial soft tissue: sonographic features with an emphasis on the pseudotestis pattern. J Ultrasound Med 2011;30:11-17 https://doi.org/10.7863/jum.2011.30.1.11
  24. Mendelson EB, Bohm-Velez M, Berg WA, Whitman GJ, Feldman MI, Madjar H, et al. ACR BI-RADS ultrasound. In: D'Orsi CJ, Sickles EA, Mendelson EB, Morris EA, eds. ACR BI-RADS atlas, breast imaging reporting and data system, 5th ed. Reston, VA: American College of Radiology, 2013:1-173
  25. Chau CL, Griffith JF. Musculoskeletal infections: ultrasound appearances. Clin Radiol 2005;60:149-159 https://doi.org/10.1016/j.crad.2004.02.005
  26. Chang CD, Wu JS. Imaging of musculoskeletal soft tissue infection. Semin Roentgenol 2017;52:55-62 https://doi.org/10.1053/j.ro.2016.10.001
  27. Turecki MB, Taljanovic MS, Stubbs AY, Graham AR, Holden DA, Hunter TB, et al. Imaging of musculoskeletal soft tissue infections. Skeletal Radiol 2010;39:957-971 https://doi.org/10.1007/s00256-009-0780-0
  28. Chandrasekaran V, Parkash S, Raghuveer CV. Epidermal cysts - a clinicopathological and biochemical study. Postgrad Med J 1980;56:823-827 https://doi.org/10.1136/pgmj.56.662.823
  29. Fullen DR. Cysts and sinuses. In: Busam KJ, Goldblum JR, eds. Dermatopathology, 2nd ed. Philadelphia, PA: Saunders, 2016:310-336
  30. Altman DG, Royston P. What do we mean by validating a prognostic model? Stat Med 2000;19:453-473 https://doi.org/10.1002/(SICI)1097-0258(20000229)19:4<453::AID-SIM350>3.0.CO;2-5
  31. Steyerberg EW, Bleeker SE, Moll HA, Grobbee DE, Moons KG. Internal and external validation of predictive models: a simulation study of bias and precision in small samples. J Clin Epidemiol 2003;56:441-447 https://doi.org/10.1016/S0895-4356(03)00047-7
  32. Yoon JH, Lee HS, Kim EK, Moon HJ, Kwak JY. A nomogram for predicting malignancy in thyroid nodules diagnosed as atypia of undetermined significance/follicular lesions of undetermined significance on fine needle aspiration. Surgery 2014;155:1006-1013 https://doi.org/10.1016/j.surg.2013.12.035
  33. Bleeker SE, Moll HA, Steyerberg EW, Donders AR, Derksen-Lubsen G, Grobbee DE, et al. External validation is necessary in prediction research: a clinical example. J Clin Epidemiol 2003;56:826-832 https://doi.org/10.1016/S0895-4356(03)00207-5
  34. Steyerberg EW, Vickers AJ, Cook NR, Gerds T, Gonen M, Obuchowski N, et al. Assessing the performance of prediction models: a framework for traditional and novel measures. Epidemiology 2010;21:128-138 https://doi.org/10.1097/EDE.0b013e3181c30fb2
  35. Widmann G, Riedl A, Schoepf D, Glodny B, Peer S, Gruber H. State-of-the-art HR-US imaging findings of the most frequent musculoskeletal soft-tissue tumors. Skeletal Radiol 2009;38:637-649 https://doi.org/10.1007/s00256-008-0602-9
  36. Elston DM. Benign tumors and cysts of the epidermis. In: Elston DM, Ferringer T, Ko CJ, Peckham S, High WA, DiCaudo DJ, eds. Dermatopathology, 3rd ed. New York, NY: Elsevier, 2019:36-53
  37. Stavros AT. Sonographic evaluation of breast cysts. In: Stavros AT, ed. Breast ultrasound. Philadelphia, PA: Lippincott Williams & Wilkins, 2004:276-350
  38. Giess CS, Raza S, Birdwell RL. Distinguishing breast skin lesions from superficial breast parenchymal lesions: diagnostic criteria, imaging characteristics, and pitfalls. Radiographics 2011;31:1959-1972 https://doi.org/10.1148/rg.317115116
  39. Yuan WH, Hsu HC, Lai YC, Chou YH, Li AF. Differences in sonographic features of ruptured and unruptured epidermal cysts. J Ultrasound Med 2012;31:265-272 https://doi.org/10.7863/jum.2012.31.2.265
  40. Jin W, Ryu KN, Kim GY, Kim HC, Lee JH, Park JS. Sonographic findings of ruptured epidermal inclusion cysts in superficial soft tissue: emphasis on shapes, pericystic changes, and pericystic vascularity. J Ultrasound Med 2008;27:171-176; quiz 177-178 https://doi.org/10.7863/jum.2008.27.2.171

피인용 문헌

  1. Ulcerated Keloid Secondary to a Coexisting Complicated Epidermal Inclusion Cyst: A Sonographic Diagnosis vol.36, pp.4, 2020, https://doi.org/10.1177/8756479320914517
  2. Overview of Ultrasound Imaging Applications in Dermatology vol.25, pp.5, 2019, https://doi.org/10.1177/1203475421999326
  3. Can ultrasound distinguish between dermatofibroma and subcutaneous epidermal tumors? - Imaging features and reproducibility vol.79, 2019, https://doi.org/10.1016/j.clinimag.2021.03.036
  4. Usefulness of strain elastography in the differential diagnosis of ruptured epidermal cyst and superficial abscess vol.41, pp.1, 2019, https://doi.org/10.14366/usg.21040