Optically Guided High-Frequency Ultrasound Shows Superior Efficacy for Preoperative Estimation of Breslow Thickness in Comparison with Multispectral Imaging: A Single-Center Prospective Validation Study

Simple Summary In this study, we focused on melanoma, a highly aggressive form of skin cancer with a rising global incidence. Melanoma's staging and treatment depend on Breslow thickness, which is usually unavailable at the initial diagnosis. We aimed to compare two novel imaging techniques, optically guided high-frequency ultrasound (OG-HFUS) and multispectral imaging (MSI), to estimate Breslow thickness and improve preoperative staging. We enrolled 101 patients with confirmed primary melanoma, categorized by tumor thickness, and utilized these imaging methods. Our findings revealed that OG-HFUS was superior compared to MSI in estimating Breslow thickness, making it a valuable tool for melanoma diagnosis and patient care. This research may enhance preoperative staging and treatment decisions in the field of melanoma, offering promising implications for patient outcomes.Abstract Melanoma is the most aggressive form of skin cancer that is known for its metastatic potential and has an increasing incidence worldwide. Breslow thickness, which determines the staging and surgical margin of the tumor, is unavailable at initial diagnosis. Novel imaging techniques for assessing Breslow thickness lack comparative data. This study evaluates optically guided high-frequency ultrasound (OG-HFUS) and multispectral imaging (MSI) for preoperative estimation of Breslow thickness and staging. We enrolled 101 patients with histologically confirmed primary melanoma and categorized them based on tumor thickness. Optically guided 33 MHz HFUS and MSI were utilized for the assessment. Our MSI-based algorithm categorized melanomas into three subgroups with a sensitivity of 62.6%, specificity of 81.3%, and fair agreement (kappa = 0.440, CI: 0.298-0.583). In contrast, OG-HFUS demonstrated a sensitivity of 91.8%, specificity of 96.0%, and almost perfect agreement (kappa = 0.858, CI: 0.763-0.952). OG-HFUS performed better than MSI in estimating Breslow thickness, emphasizing its potential as a valuable tool for melanoma diagnosis and patient management. OG-HFUS holds promise for enhancing preoperative staging and treatment decision-making in melanoma.