Differentiation of benign and malignant breast lesions by ultrasound localization microscopy

Abstract Objective We investigated the role of ultrasound localization microscopy (ULM) qualitative and quantitative parameters in distinguishing benign from malignant breast lesions. Methods The ULM qualitative and quantitative parameters of breast lesions were recorded. A receiver operating charac...

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Main Authors: Jia Li, Cong Wei, Tao Ying, Yan Liu, Ronghui Wang, Maoyao Li, Chao Feng, Di Sun, Yuanyi Zheng
Format: Article
Language:English
Published: SpringerOpen 2025-06-01
Series:Insights into Imaging
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Online Access:https://doi.org/10.1186/s13244-025-02013-6
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author Jia Li
Cong Wei
Tao Ying
Yan Liu
Ronghui Wang
Maoyao Li
Chao Feng
Di Sun
Yuanyi Zheng
author_facet Jia Li
Cong Wei
Tao Ying
Yan Liu
Ronghui Wang
Maoyao Li
Chao Feng
Di Sun
Yuanyi Zheng
author_sort Jia Li
collection DOAJ
description Abstract Objective We investigated the role of ultrasound localization microscopy (ULM) qualitative and quantitative parameters in distinguishing benign from malignant breast lesions. Methods The ULM qualitative and quantitative parameters of breast lesions were recorded. A receiver operating characteristic (ROC) curve was applied to assess the diagnostic performance of ULM. Intra- and inter-operator reliabilities of quantitative parameters were assessed. Results Thirty-one breast lesions were verified by pathologic results, 14 of which were benign and 17 were malignant. Benign lesions were associated with dot-like, line-like, or branch-like patterns (93% vs 6%), whereas malignant lesions were associated with chaotic patterns (94% vs 7%) (p < 0.001). The microvasculature morphology had an area under the curve (AUC) of 0.935, a sensitivity of 94.1%, and a specificity of 92.9%. The microvasculature density, mean diameter, largest diameter, and max tortuosity of malignant lesions were significantly greater than those of benign lesions (p < 0.05, p < 0.001, p < 0.001, p < 0.05). The microvasculature mean flow velocity of benign lesions was significantly greater than that of malignant lesions (p < 0.05). For the quantitative parameters, the AUC was highest for the microvasculature's largest diameter (0.962), with a sensitivity of 88.2% and a specificity of 92.9%. The intra- and inter-operator reliabilities of quantitative parameters were excellent (ICC greater than 0.90). Conclusions ULM is useful for distinguishing benign from malignant breast lesions. ULM can offer a new diagnostic method for breast lesions, which deserves further research. Critical relevance statement This study suggests that ULM is a new technology with super-resolution that is helpful for distinguishing benign from malignant breast lesions. Trial registration ChiCTR, ChiCTR2100048361. Registered 6 July 2021, https://www.chictr.org.cn/ . Key Points ULM is an emerging technology that can detect highly detailed networks of microvasculature. Microvasculature morphology based on ULM can be a good indicator for the differential diagnosis of breast lesions. Among quantitative parameters extracted from ULM, microvasculature largest diameter was the best for the classification of breast lesions. Graphical Abstract
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spelling doaj-art-747b5f889e614d3a81ab04cb73b830bc2025-08-20T03:47:14ZengSpringerOpenInsights into Imaging1869-41012025-06-0116111210.1186/s13244-025-02013-6Differentiation of benign and malignant breast lesions by ultrasound localization microscopyJia Li0Cong Wei1Tao Ying2Yan Liu3Ronghui Wang4Maoyao Li5Chao Feng6Di Sun7Yuanyi Zheng8Department of Ultrasound in Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of MedicineDepartment of Ultrasound in Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of MedicineDepartment of Ultrasound in Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of MedicineDepartment of Ultrasound in Medicine, Dali Bai Autonomous Prefecture People’s HospitalDepartment of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineDepartment of Ultrasound in Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of MedicineDivision of andrology, Department of reproductive medicine, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong UniversityDepartment of Ultrasound in Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of MedicineDepartment of Ultrasound in Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of MedicineAbstract Objective We investigated the role of ultrasound localization microscopy (ULM) qualitative and quantitative parameters in distinguishing benign from malignant breast lesions. Methods The ULM qualitative and quantitative parameters of breast lesions were recorded. A receiver operating characteristic (ROC) curve was applied to assess the diagnostic performance of ULM. Intra- and inter-operator reliabilities of quantitative parameters were assessed. Results Thirty-one breast lesions were verified by pathologic results, 14 of which were benign and 17 were malignant. Benign lesions were associated with dot-like, line-like, or branch-like patterns (93% vs 6%), whereas malignant lesions were associated with chaotic patterns (94% vs 7%) (p < 0.001). The microvasculature morphology had an area under the curve (AUC) of 0.935, a sensitivity of 94.1%, and a specificity of 92.9%. The microvasculature density, mean diameter, largest diameter, and max tortuosity of malignant lesions were significantly greater than those of benign lesions (p < 0.05, p < 0.001, p < 0.001, p < 0.05). The microvasculature mean flow velocity of benign lesions was significantly greater than that of malignant lesions (p < 0.05). For the quantitative parameters, the AUC was highest for the microvasculature's largest diameter (0.962), with a sensitivity of 88.2% and a specificity of 92.9%. The intra- and inter-operator reliabilities of quantitative parameters were excellent (ICC greater than 0.90). Conclusions ULM is useful for distinguishing benign from malignant breast lesions. ULM can offer a new diagnostic method for breast lesions, which deserves further research. Critical relevance statement This study suggests that ULM is a new technology with super-resolution that is helpful for distinguishing benign from malignant breast lesions. Trial registration ChiCTR, ChiCTR2100048361. Registered 6 July 2021, https://www.chictr.org.cn/ . Key Points ULM is an emerging technology that can detect highly detailed networks of microvasculature. Microvasculature morphology based on ULM can be a good indicator for the differential diagnosis of breast lesions. Among quantitative parameters extracted from ULM, microvasculature largest diameter was the best for the classification of breast lesions. Graphical Abstracthttps://doi.org/10.1186/s13244-025-02013-6Ultrasound localization microscopyBreast lesionsMicrovasculatureContrast-enhanced ultrasound
spellingShingle Jia Li
Cong Wei
Tao Ying
Yan Liu
Ronghui Wang
Maoyao Li
Chao Feng
Di Sun
Yuanyi Zheng
Differentiation of benign and malignant breast lesions by ultrasound localization microscopy
Insights into Imaging
Ultrasound localization microscopy
Breast lesions
Microvasculature
Contrast-enhanced ultrasound
title Differentiation of benign and malignant breast lesions by ultrasound localization microscopy
title_full Differentiation of benign and malignant breast lesions by ultrasound localization microscopy
title_fullStr Differentiation of benign and malignant breast lesions by ultrasound localization microscopy
title_full_unstemmed Differentiation of benign and malignant breast lesions by ultrasound localization microscopy
title_short Differentiation of benign and malignant breast lesions by ultrasound localization microscopy
title_sort differentiation of benign and malignant breast lesions by ultrasound localization microscopy
topic Ultrasound localization microscopy
Breast lesions
Microvasculature
Contrast-enhanced ultrasound
url https://doi.org/10.1186/s13244-025-02013-6
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