Nomogram Based on Super-Resolution Ultrasound Images Outperforms in Predicting Benign and Malignant Breast Lesions

Objective: To establish a good predictive model using a deep-learning (DL)-based three-dimensional (3D) super-resolution ultrasound images for the diagnosis of benign and malignant breast lesions. Methods: This retrospective study included 333 patients with histopathologically confirmed breast lesions, randomly split into training (N=266) and testing (N=67) datasets. Eight models, including four deep learning models (ORResNet101, ORMobileNet_v2, SRResNet101, SRMobileNet_v2) and four machine learning models (OR_LR, OR_SVM, SR_LR, SR_SVM), were developed based on original and super-resolution images. The best performing model was SRMobileNet_v2, which was used to construct a nomogram integrating clinical factors. The performance of nomogram was evaluated using receiver operating characteristic (ROC) analysis, decision curve analysis (DCA), and calibration curves. Results: SRMobileNet_v2, MobileNet_V2 based on super-resolution ultrasound images, had the best predictive performance in four traditional machine learning models and four deep learning models, with AUC improvements of 0.089 and 0.031 in the training and testing sets, relative to the ORMobileNet_v2 model based on original ultrasound images. The deep-learning nomogram was constructed using the SRMobileNet_v2 model score, tumor size, and patient age, resulting in superior predictive efficacy compared to the nomogram without the SRMobileNet_v2 model score. Furthermore, it demonstrated favorable calibration, discrimination, and clinical utility in both cohorts. Conclusion: The diagnostic prediction model utilizing super-resolution reconstructed ultrasound images outperforms the model based on original images in distinguishing between benign and malignant breast lesions. The nomogram based on super-resolution ultrasound images has the potential to serve as a reliable auxiliary diagnostic tool for clinicians, exhibiting superior predictive performance in distinguishing between benign and malignant breast lesions. Keywords: deep learning, radiomics, machine learning, breast lesion, super-resolution