Quantitative angiogenesis-based ultrasound biomarkers for differentiating radiologically challenging breast lesions: Radial scar vs invasive ductal carcinoma.

PURPOSE: To investigate the effectiveness of quantitative biomarkers derived from quantitative high-definition microvasculature imaging (qHDMI) for differentiation of radial scar (RS) and invasive ductal carcinoma (IDC). METHODS: A total of 64 breast lesions from 62 participants were analyzed using breast pathology as the gold standard. Ultrasound data were processed with the qHDMI framework to visualize tumor microvessel networks and extract eight morphological biomarkers. Biomarker distributions were compared between groups using a two-sided Wilcoxon rank-sum test, and ROC AUC values with 95 % confidence intervals (CI) were calculated. P-values were adjusted for multiple testing using the Benjamini-Hochberg FDR method at a 5 % threshold. RESULTS: Seventeen lesions were pathologically confirmed as RS and 47 as IDC. qHDMI biomarkers revealed distinct microvascular differences between the two groups. Overall, IDC lesions showed denser, thicker, and more complex microvessels. Five biomarkers demonstrated statistically significant distribution differences: vessel density (p-value: 0.016, adjusted p-value: 0.0288), number of vessel segments (p-value: 0.0055, adjusted p-value: 0.0288), number of branch points (p-value: 0.0098, adjusted p-value: 0.0288), maximum diameter (p-value: 0.014, adjusted p-value: 0.0288), and microvessel fractal dimension (p-value: 0.018, adjusted p-value: 0.0288). The AUC and CIs for these five biomarkers were 0.70, [0.56, 0.82] for vessel density, 0.73, [0.60, 0.86] for number of vessel segments, 0.71, [0.58, 0.83] for number of branch points, 0.70, [0.57, 0.82] for maximum diameter, and 0.70, [0.54, 0.82] for fractal dimension. CONCLUSION: Distributions of qHDMI-derived biomarkers revealed distinct microvascular structural differences between RS and IDC, suggesting qHDMI may enhance diagnostic accuracy in distinguishing the two.