Ultrasound of focal lesions of the hand and wrist: Accuracy, validity, and factors determining treatment decision

Objective: To estimate the accuracy and validity of ultrasound in evaluating focal lesions of the hand and wrist and determine the factors affecting the treatment. Materials and Methods: Eighty focal lesions were enrolled and divided into two groups (surgical and non-surgical group). The lesions in each group were subclassified as cystic, solid, vascular, and inflammation or infectious lesion, using either pathological, or ultrasound diagnosis as the reference. Results: The accuracy of ultrasound was low at 57%, 54%, 29%, and 25% for cystic, solid, vascular lesion, and inflammatory or infectious lesion, respectively. There was no significant difference between the ultrasound and clinical diagnosis for hand and wrist lesions (p-value 0.8793). Based on pathological findings, all lesions in the study were benign. The factors that were found to influence treatment (surgical versus non-surgical) in the present study relied on the ultrasound findings and size of the lesion. The ultrasound report of cyst or inflammatory or infectious tended to be followed by conservative treatment (73% and 90%, respectively). On the other hand, surgical treatment was performed if the ultrasound reports resulted as solid or vascular lesion (60% and 67%, respectively) or regarding to the larger size as well (2.5±1.8 cm in surgical versus 1.5±1.1 cm in non-surgical group). Conclusion: The accuracy of ultrasound evaluation of focal lesions in the hand and wrist is low (25% to 57%). However, the lesions with larger size or the solid and vascular lesions had more tendency to undergo surgery. Therefore, ultrasound may help suggesting the therapeutic decision.