XBusNet: Text-Guided Breast Ultrasound Segmentation via Multimodal Vision-Language Learning.

Background/Objectives: Precise breast ultrasound (BUS) segmentation supports reliable measurement, quantitative analysis, and downstream classification yet remains difficult for small or low-contrast lesions with fuzzy margins and speckle noise. Text prompts can add clinical context, but directly applying weakly localized text-image cues (e.g., CAM/CLIP-derived signals) tends to produce coarse, blob-like responses that smear boundaries unless additional mechanisms recover fine edges. Methods: We propose XBusNet, a novel dual-prompt, dual-branch multimodal model that combines image features with clinically grounded text. A global pathway based on a CLIP Vision Transformer encodes whole-image semantics conditioned on lesion size and location, while a local U-Net pathway emphasizes precise boundaries and is modulated by prompts that describe shape, margin, and Breast Imaging Reporting and Data System (BI-RADS) terms. Prompts are assembled automatically from structured metadata, requiring no manual clicks. We evaluate the model on the Breast Lesions USG (BLU) dataset using five-fold cross-validation. The primary metrics are Dice and Intersection over Union (IoU); we also conduct size-stratified analyses and ablations to assess the roles of the global and local paths and the text-driven modulation. Results: XBusNet achieves state-of-the-art performance on BLU, with a mean Dice of 0.8766 and IoU of 0.8150, outperforming six strong baselines. Small lesions show the largest gains, with fewer missed regions and fewer spurious activations. Ablation studies show complementary contributions of global context, local boundary modeling, and prompt-based modulation. Conclusions: A dual-prompt, dual-branch multimodal design that merges global semantics with local precision yields accurate BUS segmentation masks and improves robustness for small, low-contrast lesions.