Hybrid Diffusion Model for Breast Ultrasound Image Augmentation

Lung ultrasound (LUS) is a safe and portable imaging modality, but the scarcity of data limits the development of machine learning methods for image interpretation and disease monitoring. Existing generative augmentation methods, such as Generative Adversarial Networks (GANs) and diffusion models, often lose subtle diagnostic cues due to resolution reduction, particularly B-lines and pleural irregularities. We propose A trous Wavelet Diffusion (AWDiff), a diffusion based augmentation framework that integrates the a trous wavelet transform to preserve fine-scale structures while avoiding destructive downsampling. In addition, semantic conditioning with BioMedCLIP, a vision language foundation model trained on large scale biomedical corpora, enforces alignment with clinically meaningful labels. On a LUS dataset, AWDiff achieved lower distortion and higher perceptual quality compared to existing methods, demonstrating both structural fidelity and clinical diversity.

Conditional diffusion models can generate anatomically plausible medical ultrasound (US) images, but anatomical plausibility alone does not ensure realistic B-mode appearance. Most US pipelines adapt standard generative architectures and condition them on anatomical masks, or use guidance mechanisms that reinforce the same anatomical signal. However, B-mode US images are shaped by acquisition-dependent properties such as speckle texture, tissue contrast, and attenuation. Using a frozen US foundation model, we show that standard conditional diffusion baselines remain separated from real images in representation space. In this work, we propose Feature-Space Candidate Guidance (FSCG), a training-free sampling strategy to reduce this gap. At sampling time, FSCG applies local k-NN feature correction and selects the best of multiple stochastic candidates according to their feature-space energy. In this way, the mask defines the anatomy, while FSCG steers samples toward the real US domain. Across three different datasets, FSCG reduces average FID64 by 56%, FID192 by 57%, and nearest-neighbour feature distance by 47% over standard conditional diffusion sampling, outperforming alternative inference-time guidance baselines. The results suggest that domain-aware feature representations can reveal and reduce realism gaps in medical diffusion synthesis without retraining the generator. Our code is available at https://github.com/marinadominguez/FSCG.

Accurate classification of breast ultrasound images into benign, malignant, and normal categories is a critical clinical task complicated by speckle noise, acoustic shadowing, and inter-class visual ambiguity. Existing deep learning methods rely on single-stream architectures with generic augmentation that ignores ultrasound acquisition physics, and no prior method dedicates a stream to the lesion boundary features identified as the most diagnostically significant visual cue. We propose HADS-Net, a Hybrid Attention-Augmented Dual-Stream Network exploiting global texture and local boundary cues through two parallel pathways. Stream 1 applies physics-informed augmentation simulating speckle noise, acoustic shadowing, and gain variation before extracting features via pretrained EfficientNet-B3 projected to 512 dimensions. Stream 2 extracts Sobel edge maps processed by a lightweight CNN projected to the same 512-dimensional space. A cross-attention fusion module allows the texture stream to selectively query boundary features, producing a jointly optimised representation classified by an MLP trained with adaptive class-weighted focal loss. Five-fold stratified cross-validation with cosine annealing over 50 epochs is used, with the globally best checkpoint selected by lowest validation loss evaluated on a held-out test set. On the BUSI dataset, HADS-Net achieves 96.58% accuracy, macro ROC-AUC of 0.9978, macro F1 of 0.9654, and per-class F1-scores of 0.970, 0.951, and 0.976 for benign, malignant, and normal. No malignant lesion is misclassified as normal. These results confirm that modality-specific augmentation with cross-modal attention fusion is an effective strategy for ultrasound-based breast cancer diagnosis.