Abstract
Microvessel orientations are known to differ between benign and malignant tumors. This article introduces novel orientation-based quantitative biomarkers for contrast-free ultrasound microvasculature imaging to distinguish malignant from benign breast lesions. The proposed biomarkers were computed in both polar and Cartesian coordinates using images acquired by a high-definition microvasculature imaging technique. Seven biomarkers were derived based on the histogram, gradient angle, angle of penetration, and penetration factor of the microvessel. These biomarkers are first evaluated using simulated microvessel images and subsequently validated in in vivo studies on human breast masses. The new biomarkers demonstrated statistical significance in differentiating benign from malignant breast masses. In the in vivo study, the area under the receiver operating characteristic curve (AUC) for the proposed biomarkers was 0.91 (95% confidence interval [CI]: 0.86, 0.97). When the Breast Imaging Reporting and Data System (BI-RADS) score was included in the classification model, the AUC improved to 0.97 (95% CI: 0.91,1.00). These orientation-based biomarkers show promise in enhancing the diagnostic performance of ultrasound for classification of breast masses.