Абстракт

Objectives: The clinical evaluation of edematous-fibrosclerotic panniculopathy (PEFS), based on clinical criteria as in the classification of Nürnberger and Muller (1978), does not always allow an objective and reproducible analysis of the severity and morphology of the disease. High-frequency ultrasound is now a reliable diagnostic tool for the structural analysis of subcutaneous tissue. The aim of this study is to propose a new ultrasound classification of advanced cellulite: the IEC Scale (Intagliata Echo Cellulite Scale), which systematically divides stage 3 into subtypes 3A, 3B and "mixed", in order Introduction: Stage III cellulite is traditionally assessed through clinical inspection; however, visual scales often fail to capture the structural complexity of subcutaneous tissue. High-frequency ultrasound (HFUS) provides an objective, non-invasive method for visualizing the architecture of adipose tissue. This study aimed to develop and validate an ultrasound-based subclassification of stage III cellulite to improve diagnostic accuracy and facilitate personalized treatment strategies. Materials / method: This observational cohort study included 150 female patients (ages 20–55 years, BMI 18–32 kg/m2) with a clinical diagnosis of stage III cellulite. Two physicians independently performed clinical staging (3A/3B) using the Nürnberger–Müller scale. A single physician conducted HFUS examinations of the subgluteal and trochanteric regions using a 20-MHz probe. Ultrasound features, including fat thickness, echotexture, fibrosis, and edema, served to classify patients into three phenotypes: 3A, 3B, and mixed. Results: HFUS identified 50 patients in each subtype. The mean superficial fat thickness was 4.8 ± 1.1 mm in 3A, 11.3 ± 2.4 mm in 3B, and 8.6 ± 3.4 mm in mixed subtype. Severe fibrosis occurred in 100.0% of patients with type 3B, was absent in type 3A, and was variable in the mixed type. Edema was mild in all patients with type 3A (100.0%), severe in 44.0% of those with type 3B, and variable in the mixed group. Discrepancies between clinical and ultrasound classifications appeared in 33.3% of cases. Agreement between classifications was moderate (Gwet’s AC1 = 0.444; p < 0.001). Conclusion: HFUS provides a valid and reproducible method for structurally assessing advanced cellulite. It enables the identification of a third, clinically unrecognized mixed phenotype, which has significant therapeutic implications by supporting more accurate treatment selection and improving treatment personalization.