Application of Super-Resolution Ultrasound Contrast Imaging in Differentiating Benign From Malignant Breast Tumors

Abstract

This study evaluated the utility of super-resolution ultrasound contrast imaging for differentiating benign from malignant breast tumors. In this retrospective study, 60 patients underwent contrast-enhanced ultrasound acquisition before biopsy or surgery excision at The Third Affiliated Hospital of Nanjing Medical University between March and November 2025. Super-resolution contrast-enhanced ultrasound (SRUS) reconstruction and quantitative analysis were then performed from contrast-enhanced ultrasound cine loops using microbubble localization and tracking software. Using histopathology as the reference standard, patients were classified into malignant and benign groups. The discriminatory value of each parameter for benign versus malignant breast tumors was assessed. Diagnostic performance was quantified using the area under the receiver operating characteristic curve (AUC). The diagnostic performance of each SRUS-derived parameter was evaluated for differentiating benign from malignant breast tumors. On final pathology, SRUS-derived parameters showed good performance for differentiating benign from malignant breast tumors. Compared with benign lesions, malignant tumors exhibited significantly higher FD, number of branching points per area maximum curvature, mean curvature, maximum vessel velocity, mean vessel velocity, maximum diameter, mean diameter, and microvasculature density (all p < .050). Among all parameters, maximum curvature achieved the highest AUC (0.933), with 88.0% sensitivity and 80.0% specificity. Intra- and inter-operator reliability were high, with intraclass correlation coefficients >.85. SRUS-derived quantitative parameters showed diagnostic value for differentiating benign from malignant breast masses and enable clear visualization of hemodynamic alterations, suggesting potential value for preoperative malignant-risk assessment.