A Nomogram for Predicting Benign and Malignant Skin Tumors Using Multimodal Ultrasound

Abstract

This study aimed to investigate the diagnostic and differential value of high frequency ultrasound (HFUS), shear wave elastography (SWE), and superb microvascular imaging (SMI) for benign and malignant skin tumors, both individually and in combination. A total of 155 patients diagnosed with skin tumors via surgical treatment or puncture biopsy at the First Affiliated Hospital of Dalian Medical University were included in the study. The findings from HFUS, SWE, and SMI were recorded for each case. Pathological results served as the gold standard for comparing the differential diagnostic value of these parameters in benign and malignant skin tumors. Independent risk factors were further screened to construct a nomogram model, which was evaluated using receiver operating characteristic curves, decision curves, and calibration curves. Among the 155 patients with skin tumors, 107 were benign, and 48 were malignant. HFUS revealed significant differences in maximum diameter, internal echo, basal boundary, morphology, and blood flow grading between benign and malignant skin tumors (p < .05). In SWE, the maximum shear elastic modulus (E-max) of malignant skin tumors was significantly higher than that of benign tumors (p < .05). In SMI, the vascular index was significantly higher in the malignant group compared to the benign group (p < .001). Multivariate logistic regression identified boundary, maximum diameter, vascular index, and age as independent risk factors, leading to the development of a nomogram model. This model demonstrated an AUC of 0.935 (95% CI: 0.893–0.978), with a sensitivity of 85.4% and a specificity of 90.7%, indicating strong diagnostic value. HFUS, SWE, and SMI possess certain differential diagnostic capabilities for benign and malignant skin tumors. The nomogram model enhances the discrimination between benign and malignant tumors, providing precise diagnostic criteria and significant clinical relevance for the diagnosis of skin tumors.