From Ultrasound to Histopathology: Agreement Analysis and Depth Correction Model for Basal Cell Carcinoma Using a Portable 20 MHz High-Frequency Ultrasound Device

Popescu, Cristina; Iliescu, Carmen Andrada; Truica, Andreea Mihaela; Popa, Liliana Gabriela; Porosnicu, Andrei Ludovic; Tudose, Irina; Boeru, Carmen; Popescu, Marius Nicolae

doi:10.3390/diagnostics16070978

Open AccessArticle

From Ultrasound to Histopathology: Agreement Analysis and Depth Correction Model for Basal Cell Carcinoma Using a Portable 20 MHz High-Frequency Ultrasound Device

by

Cristina Popescu

^1,2

,

Carmen Andrada Iliescu

^2,*

,

Andreea Mihaela Truica

^2,*,

Liliana Gabriela Popa

^1,2

,

Andrei Ludovic Porosnicu

³,

Irina Tudose

⁴,

Carmen Boeru

⁵ and

Marius Nicolae Popescu

⁶

¹

Department of Oncologic Dermatology, Elias Emergency University Hospital, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania

²

Clinic of Dermatology, Elias Emergency University Hospital, 011461 Bucharest, Romania

³

Department of Plastic and Reconstructive Surgery, Elias Emergency University Hospital, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania

⁴

Histopathology Department, Elias University Emergency Hospital, 011461 Bucharest, Romania

⁵

Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania

⁶

Department of Physical and Rehabilitation Medicine, Elias Emergency University Hospital, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania

^*

Authors to whom correspondence should be addressed.

Diagnostics 2026, 16(7), 978; https://doi.org/10.3390/diagnostics16070978

Submission received: 3 February 2026 / Revised: 17 March 2026 / Accepted: 23 March 2026 / Published: 25 March 2026

(This article belongs to the Special Issue Application of Ultrasound Imaging in Clinical Diagnosis)

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Abstract

Background: High-frequency ultrasound (HFUS) represents a valuable non-invasive imaging modality for assessing cutaneous tumors. In basal cell carcinoma (BCC), preoperative estimation of tumor depth may support therapeutic decision-making and surgical planning. However, agreement between HFUS-derived and histopathologic depth measurements remains incompletely characterized, particularly with 20 MHz probes in routine clinical practice. Objectives: To evaluate agreement between 20 MHz HFUS and histopathology for BCC tumor depth using Bland–Altman analysis and to derive a preliminary correction equation to estimate histologic depth from HFUS measurements. Methods: This prospective observational pilot study included 15 patients with 16 histologically confirmed BCC lesions. All lesions underwent preoperative 20 MHz HFUS followed by surgical excision, with HFUS-derived tumor depth compared with histopathologic depth. Agreement was assessed using Bland–Altman analysis, and linear regression was performed to derive a preliminary correction equation. Results: Sixteen BCC lesions were analyzed. The mean difference between HFUS and histopathologic tumor depth was −0.07 mm, with 95% limits of agreement from −1.58 to +1.45 mm. HFUS and histopathologic depth measurements were highly correlated (R² = 0.99). A correction equation was derived: estimated histopathologic depth (mm) = −0.52 + 1.10 × HFUS depth (mm). Conclusions: Twenty MHz HFUS demonstrated good agreement with histopathology for tumor depth assessment in BCC, with clinically acceptable variability. The proposed correction equation may improve interpretation of HFUS measurements; however, further validation in larger cohorts is required.

Keywords: basal cell carcinoma; high-frequency ultrasound; tumor depth; Bland–Altman analysis; non-invasive imaging

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MDPI and ACS Style

Popescu, C.; Iliescu, C.A.; Truica, A.M.; Popa, L.G.; Porosnicu, A.L.; Tudose, I.; Boeru, C.; Popescu, M.N. From Ultrasound to Histopathology: Agreement Analysis and Depth Correction Model for Basal Cell Carcinoma Using a Portable 20 MHz High-Frequency Ultrasound Device. Diagnostics 2026, 16, 978. https://doi.org/10.3390/diagnostics16070978

AMA Style

Popescu C, Iliescu CA, Truica AM, Popa LG, Porosnicu AL, Tudose I, Boeru C, Popescu MN. From Ultrasound to Histopathology: Agreement Analysis and Depth Correction Model for Basal Cell Carcinoma Using a Portable 20 MHz High-Frequency Ultrasound Device. Diagnostics. 2026; 16(7):978. https://doi.org/10.3390/diagnostics16070978

Chicago/Turabian Style

Popescu, Cristina, Carmen Andrada Iliescu, Andreea Mihaela Truica, Liliana Gabriela Popa, Andrei Ludovic Porosnicu, Irina Tudose, Carmen Boeru, and Marius Nicolae Popescu. 2026. "From Ultrasound to Histopathology: Agreement Analysis and Depth Correction Model for Basal Cell Carcinoma Using a Portable 20 MHz High-Frequency Ultrasound Device" Diagnostics 16, no. 7: 978. https://doi.org/10.3390/diagnostics16070978

APA Style

Popescu, C., Iliescu, C. A., Truica, A. M., Popa, L. G., Porosnicu, A. L., Tudose, I., Boeru, C., & Popescu, M. N. (2026). From Ultrasound to Histopathology: Agreement Analysis and Depth Correction Model for Basal Cell Carcinoma Using a Portable 20 MHz High-Frequency Ultrasound Device. Diagnostics, 16(7), 978. https://doi.org/10.3390/diagnostics16070978

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From Ultrasound to Histopathology: Agreement Analysis and Depth Correction Model for Basal Cell Carcinoma Using a Portable 20 MHz High-Frequency Ultrasound Device

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