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We aimed to investigate the diagnostic value of HFUS in invisible subcutaneous lesions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Patients with invisible subcutaneous lesions were prospectively recruited from two centres. Before undergoing biopsy or surgery, each lesion was independently evaluated by two clinicians. One provides a clinical diagnosis by only clinical examination and the other provides an integrated diagnosis by combining clinical examination and HFUS information. Diagnoses were classified as correct, wrong, and indeterminate. A total of 391 lesions from 355 patients were enrolled, including 225 epidermoid cysts, 77 lipomas, 25 pilomatrixomas, 21 haemangiomas, 19 dermatofibromas, 11 dermatofibrosarcoma protuberans (DFSP), 7 neurofibromas, and 6 leiomyomas. Using pathological results as the gold standard, diagnostic performance was compared.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The number of correct diagnoses increased from 185 (47.3%) by clinical examination alone to 316 (80.8%) after the addition of HFUS (P\u00a0&lt;\u00a00.05). Meanwhile, the indeterminate diagnosis rate decreased from 143 (36.6%) to 10 (2.6%). Using HFUS, the accuracy improved significantly for epidermoid cysts (59.6%\u00a0vs. 86.7%), lipomas (50.6%\u00a0vs. 94.8%), pilomatrixomas (0%\u00a0vs. 48.0%), haemangiomas (23.8%\u00a0vs. 57.1%), and DFSPs (0%\u00a0vs. 81.8%) (all <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.05). However, HFUS did not significantly improve the diagnostic accuracy of dermatofibromas (15.8%\u00a0vs. 21.1%, <jats:italic>p<\/jats:italic>\u00a0&gt;\u00a00.999), neurofibromas (42.9%\u00a0vs. 71.4%, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.625), or leiomyomas (16.7%\u00a0vs. 100%, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.063).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Combining HFUS and clinical examination can generally improve the diagnostic accuracy and decrease the indeterminacy of invisible subcutaneous lesions, especially epidermoid cysts, lipomas, pilomatrixomas, haemangiomas, and DFSPs. However, for some rare lesions, HFUS cannot provide useful information.<\/jats:p><\/jats:sec>","DOI":"10.1111\/srt.13464","type":"journal-article","created":{"date-parts":[[2023,9,11]],"date-time":"2023-09-11T00:58:58Z","timestamp":1694393938000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Diagnostic value of high\u2010frequency ultrasound (HFUS) in evaluation of subcutaneous lesions"],"prefix":"10.1111","volume":"29","author":[{"given":"Yao","family":"Miao","sequence":"first","affiliation":[{"name":"Department of Medical Ultrasound Shanghai Tenth People's Hospital; Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment School of Medicine Tongji University  Shanghai China"},{"name":"Department of Medical Ultrasound Shanghai Skin Disease Hospital School of Medicine Tongji University  Shanghai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei\u2010Wei","family":"Ren","sequence":"additional","affiliation":[{"name":"Department of Medical Ultrasound Shanghai Tenth People's Hospital; Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment School of Medicine Tongji University  Shanghai China"},{"name":"Department of Medical Ultrasound Shanghai Skin Disease Hospital School of Medicine Tongji University  Shanghai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fei\u2010Yue","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Medical Ultrasound Shanghai Tenth People's Hospital; Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment School of Medicine Tongji University  Shanghai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liang","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Dermatological Surgery Shanghai Skin Disease Hospital School of Medicine Tongji University  Shanghai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ling","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Dermatological Surgery Shanghai Skin Disease Hospital School of Medicine Tongji University  Shanghai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dan\u2010","family":"Dan Shan","sequence":"additional","affiliation":[{"name":"Department of Medical Ultrasound Shanghai Tenth People's Hospital; Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment School of Medicine Tongji University  Shanghai China"},{"name":"Department of Medical Ultrasound Shanghai Skin Disease Hospital School of Medicine Tongji University  Shanghai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zi\u2010Tong","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Medical Ultrasound Shanghai Tenth People's Hospital; Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment School of Medicine Tongji University  Shanghai China"},{"name":"Department of Medical Ultrasound Shanghai Skin Disease Hospital School of Medicine Tongji University  Shanghai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li\u2010Fan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Ultrasound Zhongshan Hospital Fudan University  Shanghai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qiao","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Medical Ultrasound Shanghai Tenth People's Hospital; Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment School of Medicine Tongji University  Shanghai China"},{"name":"Department of Medical Ultrasound Shanghai Skin Disease Hospital School of Medicine Tongji University  Shanghai 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