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.