Development and Validation of a Combined 2D-US and CDUS Nomogram for Differentiating Benign and Malignant Breast...

To investigate the differential imaging features of benign and malignant breast masses using two-dimensional ultrasonography (2D-US) and color Doppler ultrasonography (CDUS) and to develop a combined imaging-based predictive nomogram for risk stratification of malignancy.

A single-center retrospective study was conducted, analyzing 258 patients with breast masses who underwent 2D-US and CDUS and had definitive pathological diagnoses between May 2023 and June 2025, including 177 benign and 81 malignant cases. Demographic and imaging characteristics were compared between the two groups. Independent predictors of malignancy were identified using multivariate logistic regression, based on which a predictive nomogram was constructed. Model performance and calibration were evaluated using receiver operating characteristic (ROC) curve analysis, the Hosmer-Lemeshow goodness-of-fit test, and bootstrap resampling.

Patients in the malignant were older and exhibited larger tumor diameters and higher Breast Imaging Reporting and Data System (BI-RADS) categories. On 2D-US, irregular morphology, indistinct boundary, lobulated or spiculated margin, and microcalcifications. CDUS revealed significantly higher Adler grades in the malignant cases. Age, tumor diameter, BI-RADS category, morphology, boundary, margin, and Adler grade were independent predictors of malignancy. The combined imaging nomogram demonstrated an area under the ROC curve (AUC) of 0.926 (95% confidence interval [CI]: 0.892-0.959), with 83.95% sensitivity and 89.27% specificity, showing good calibration and discriminatory ability.

The developed nomogram integrating 2D-US and CDUS imaging features provides good discriminatory performance and risk stratification capability for differentiating benign from malignant breast masses. These findings support its potential utility in clinical decision-making, although external validation in independent cohorts is warranted to confirm generalizability.