Diagnostic value of super-resolution ultrasound imaging in differentiating benign and malignant BI-RADS-4 breast lesions.

Objective: Benign and malignant breast tumors exhibit distinct microvascular morphological patterns and spatial distribution characteristics; however, current clinical imaging modalities cannot comprehensively assess their microvascular network architecture. Super-resolution ultrasound (SRUS) imaging addresses this critical gap by providing super-resolved visualization of microvascular topology. This study aimed to evaluate the utility of SRUS imaging in visualizing breast lesion microvasculature and establishing diagnostic models for BI-RADS 4 masses. Methods: A total of 120 breast lesions from 117 patients with conventional ultrasound-confirmed BI-RADS 4 lesions were prospectively enrolled in this study between July 2024 and January 2025. Preoperative conventional ultrasound and SRUS examinations were performed on all included patients. Based on pathological findings, the lesions were categorized as benign (n = 85) or malignant (n = 35). The benign group was further stratified into hypovascular (n = 42) and hypervascular (n = 43) subgroups based on the SRUS enhancement levels. Univariate analysis was performed to screen SRUS parameters, and variables with Results: Max vel (OR = 1.848, 95% CI: 1.205-3.122), curvature (A/E) (OR = 2.162, 95% CI: 1.981-2.323), and complexity level (OR = 1.772, 95% CI: 1.608-1.942) independently predicted malignancy (all Conclusion: SRUS enables microvascular characterization of breast lesions, with validated nomograms demonstrating high diagnostic accuracy for early cancer detection.