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Σάββατο 25 Μαΐου 2019

Ultrasound as a Diagnostic and Management Tool in Hidradenitis Suppurativa Patients: A Multicenter Study
A Martorell  F Alfageme Roldán  E Vilarrasa Rull  R Ruiz‐Villaverde  J Romaní De Gabriel  F García Martínez  D Vidal Sarro  M Velasco Pastor  C Ciudad Blanco  J M Segura Palacios … See all authors
First published: 24 May 2019 https://doi.org/10.1111/jdv.15710
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/jdv.15710
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Abstract
Background
It has been reported that clinical evaluation consistently underestimates the severity of hidradenitis suppurativa (HS).

Objective
To determine the usefulness of ultrasound as a diagnostic tool in HS compared with clinical examination and to assess the subsequent modification of disease management.

Methods
Cross‐sectional multicenter study. Severity classification and therapeutic approach according to clinical versus ultrasound examination were compared.

Results
143 HS patients were included. Clinical examination scored 38, 70, and 35 patients as Hurley stage I, II, and III, respectively; with ultrasound examination, 21, 80, and 42 patients were staged with Hurley stage I, II, and III disease, respectively (p<0.01). In patients with stage I classification as determined by clinical examination, 44.7% changed to a more severe stage. Clinical examination indicated that 44.1%, 54.5%, and 1.4% of patients would maintain, increase, or decrease treatment, respectively. For ultrasound examination, these percentages were 31.5%, 67.1%, and 1.4% (p<0.01). Concordance between clinical and ultrasound intra‐rater examination was 22.8% (p<0.01); intra‐rater and inter‐rater (radiologist) ultrasound agreement was 94.9% and 81.7%, respectively (p<0.01).

Limitations
The inability to detect lesions that measure ≤0.1 mm or with only epidermal location.

Conclusion
Ultrasound can modify the clinical staging and therapeutic management in HS by detecting subclinical disease.

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