Ultrasound and elastography in the assessment of skin involvement in systemic sclerosis : A systematic literature review focusing on validation and standardization – WSF Skin Ultrasound Group
(2022) In Seminars in Arthritis and Rheumatism 52.- Abstract
Objective: To summarize the published evidence in the literature on the role of ultrasound and elastography to assess skin involvement in systemic sclerosis (SSc). Methods: A systematic literature review (SLR) was performed within the “Skin Ultrasound Working Group” of the World Scleroderma Foundation, according to the Cochrane Handbook. A search was conducted in Pubmed, Cochrane Library and Embase databases from 1/1/1979 to 31/5/2021, using the participants, intervention, comparator and outcomes (PICO) framework. Only full-text articles involving adults, reported in any language, assessing ultrasound to quantify skin pathology in SSc patients. Two reviewers performed the assessment of risk of bias, data extraction and synthesis,... (More)
Objective: To summarize the published evidence in the literature on the role of ultrasound and elastography to assess skin involvement in systemic sclerosis (SSc). Methods: A systematic literature review (SLR) was performed within the “Skin Ultrasound Working Group” of the World Scleroderma Foundation, according to the Cochrane Handbook. A search was conducted in Pubmed, Cochrane Library and Embase databases from 1/1/1979 to 31/5/2021, using the participants, intervention, comparator and outcomes (PICO) framework. Only full-text articles involving adults, reported in any language, assessing ultrasound to quantify skin pathology in SSc patients. Two reviewers performed the assessment of risk of bias, data extraction and synthesis, independently. Results: Forty-six studies out of 3248 references evaluating skin ultrasound and elastography domains were included. B-mode ultrasound was used in 30 studies (65.2%), elastography in nine (19.6%), and both methods in seven (15.2%). The ultrasound outcome measure domains reported were thickness (57.8%) and echogenicity (17.2%); the elastography domain was stiffness (25%). Methods used for image acquisition and analysis were remarkably heterogeneous and frequently under-reported, precluding data synthesis across studies. The same applies to contextual factors and feasibility. Our data syntheses indicated evidence of good reliability and convergent validity for ultrasound thickness evaluation against mRSS and skin histological findings. Stiffness and echogenicity have limited evidence for validity against histological findings. Evidence for sensitivity to change, test-retest reliability, clinical trial discrimination or thresholds of meaning is limited or absent for reported ultrasound domains. Conclusion: Ultrasound is a valid and reliable tool for skin thickness measurement in SSc but there are significant knowledge gaps regarding skin echogenicity assessment by ultrasound and skin stiffness evaluation by elastography in terms of feasibility, validity and discrimination. Standardization of image acquisition and analysis is needed to foster progress.
(Less)
- author
- organization
- publishing date
- 2022
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Skin elastography, Skin ultrasound, Systemic sclerosis
- in
- Seminars in Arthritis and Rheumatism
- volume
- 52
- article number
- 151954
- publisher
- W.B. Saunders
- external identifiers
-
- scopus:85122970167
- pmid:35039184
- ISSN
- 0049-0172
- DOI
- 10.1016/j.semarthrit.2022.151954
- language
- English
- LU publication?
- yes
- id
- e1ee2dbf-4bbe-4869-a731-5e61750341d0
- date added to LUP
- 2022-02-24 15:41:42
- date last changed
- 2024-06-15 19:43:10
@article{e1ee2dbf-4bbe-4869-a731-5e61750341d0,
abstract = {{<p>Objective: To summarize the published evidence in the literature on the role of ultrasound and elastography to assess skin involvement in systemic sclerosis (SSc). Methods: A systematic literature review (SLR) was performed within the “Skin Ultrasound Working Group” of the World Scleroderma Foundation, according to the Cochrane Handbook. A search was conducted in Pubmed, Cochrane Library and Embase databases from 1/1/1979 to 31/5/2021, using the participants, intervention, comparator and outcomes (PICO) framework. Only full-text articles involving adults, reported in any language, assessing ultrasound to quantify skin pathology in SSc patients. Two reviewers performed the assessment of risk of bias, data extraction and synthesis, independently. Results: Forty-six studies out of 3248 references evaluating skin ultrasound and elastography domains were included. B-mode ultrasound was used in 30 studies (65.2%), elastography in nine (19.6%), and both methods in seven (15.2%). The ultrasound outcome measure domains reported were thickness (57.8%) and echogenicity (17.2%); the elastography domain was stiffness (25%). Methods used for image acquisition and analysis were remarkably heterogeneous and frequently under-reported, precluding data synthesis across studies. The same applies to contextual factors and feasibility. Our data syntheses indicated evidence of good reliability and convergent validity for ultrasound thickness evaluation against mRSS and skin histological findings. Stiffness and echogenicity have limited evidence for validity against histological findings. Evidence for sensitivity to change, test-retest reliability, clinical trial discrimination or thresholds of meaning is limited or absent for reported ultrasound domains. Conclusion: Ultrasound is a valid and reliable tool for skin thickness measurement in SSc but there are significant knowledge gaps regarding skin echogenicity assessment by ultrasound and skin stiffness evaluation by elastography in terms of feasibility, validity and discrimination. Standardization of image acquisition and analysis is needed to foster progress.</p>}},
author = {{Santiago, Tânia and Santos, Eduardo and Ruaro, Barbara and Lepri, Gemma and Green, Lorraine and Wildt, Marie and Watanabe, Shinji and Lescoat, Alain and Hesselstrand, Roger and Galdo, Francesco Del and Pauling, John D. and Iagnocco, Annamaria and da Silva, J. A.P.}},
issn = {{0049-0172}},
keywords = {{Skin elastography; Skin ultrasound; Systemic sclerosis}},
language = {{eng}},
publisher = {{W.B. Saunders}},
series = {{Seminars in Arthritis and Rheumatism}},
title = {{Ultrasound and elastography in the assessment of skin involvement in systemic sclerosis : A systematic literature review focusing on validation and standardization – WSF Skin Ultrasound Group}},
url = {{http://dx.doi.org/10.1016/j.semarthrit.2022.151954}},
doi = {{10.1016/j.semarthrit.2022.151954}},
volume = {{52}},
year = {{2022}},
}