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. 2025 Jun 5;15(11):1442.
doi: 10.3390/diagnostics15111442.

Preoperative Tunnel Measurement in Hidradenitis Suppurativa: Comparison of Palpation and Ultrasound

Aslı Tatlıparmak  1 , Murat Doğan  2 , Zafer Türkoğlu  2
Affiliations

Preoperative Tunnel Measurement in Hidradenitis Suppurativa: Comparison of Palpation and Ultrasound

Aslı Tatlıparmak et al. Diagnostics (Basel). .

Abstract

Background/Objectives: The accurate measurement of tunnel lengths in hidradenitis suppurativa (HS) is critical for surgical planning. This study aimed to evaluate the agreement between palpation and high-frequency ultrasound (USG) for assessing tunnel lengths in HS patients. Methods: This prospective study included patients who underwent the surgical excision of tunnels between May 2024 and July 2024 at a referral dermatology clinic. Tunnel lengths were measured preoperatively using palpation and USG. Clinical and demographic data, including lesion localization and disease severity, were prospectively recorded and analyzed. Results: This study analyzed 121 lesions from patients undergoing surgical excision for HS. Tunnel lengths measured by palpation had a median of 30 mm [IQR 18-40], while USG measurements had a median of 36 mm [IQR 24-51.5], with USG identifying tunnels 10.3 mm longer on average (95% CI: 8.2-12.3). Axillary lesions were most frequent (53.7%), followed by inguinal (32.2%) and sacral regions (6.6%). Most lesions were classified as Hurley stage 2 (59.5%) and stage 3 (37.2%), with a median IHS4 score of 8 [IQR 7-11]. Conclusions: High-frequency USG offers greater precision than palpation in measuring tunnel lengths, indicating its potential to enhance disease assessments in HS.

Keywords: hidradenitis suppurativa; palpation; surgical planning; tunnel length; ultrasound.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Clinical and sonographic images of axillary tunnels in hidradenitis suppurativa. (a) Clinical image showing a single, wide, linear axillary tunnel with superficial tract formation. (b) Corresponding ultrasound image demonstrating a straight, hypoechoic tunnel in the subcutaneous tissue; the tunnel length was similarly estimated by palpation and ultrasound. (c) Clinical image showing a narrow, fibrotic axillary tunnel with subtle skin depression and no overt sinus tract. (d) Corresponding ultrasound image revealing a deeper, hypoechoic tunnel extending beyond the clinical margins, showing greater extension than clinically appreciable by palpation. High-frequency ultrasound images were obtained using a 20 MHz linear probe (Clarius L20 HD3, Clarius Mobile Health Corp., Vancouver, BC, Canada).
Figure 2
Figure 2
Bland–Altman plot comparing tunnel length measurements by palpation and ultrasound.
Figure 3
Figure 3
Passing–Bablok regression plot comparing tunnel length measurements by palpation and ultrasound.
See this image and copyright information in PMC

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