Predicting phototherapy efficacy in vulvar lichen sclerosus using high-frequency ultrasound combined with superb microvascular imaging

Objectives: To develop a non-invasive model predicting narrow-band UVB (NB-UVB) phototherapy efficacy in vulvar lichen sclerosus (VLS) using high-frequency ultrasound (HF-US, 24 MHz) and superb microvascular imaging (SMI) parameters. Methods: Forty-seven biopsy-confirmed VLS patients undergoing standardized NB-UVB (24 weeks) were enrolled (2021-2024). Baseline vascular density (VD), vessel index (VI, SMI), and dermal thickness (HF-US) were measured. SMI parameters were assessed in the most vascularized lesion area (comprehensive lesion coverage was performed). Clinical response (6 months post-treatment) followed a modified ISSVD composite endpoint. Univariate/multivariate logistic regression and ROC analyses (AUC, sensitivity, specificity) were used, adjusted for age and disease duration. Results: = 0.003). Baseline VD (OR = 1.85) and VI (OR = 2.02) were independent predictors. The combined model showed superior performance (AUC = 0.849, 88.9% sensitivity, 80.0% specificity). Conclusion: HF-US/SMI-derived baseline VD and VI enable accurate prediction of NB-UVB response in VLS, supporting individualized pre-treatment decisions.