Boot-and-Feedback Framework for Generalist-Expert Model Collaboration in Breast Ultrasound Diagnosis

Most existing artificial intelligence systems for breast ultrasound rely primarily on image-driven prediction, with limited incorporation of the knowledge from the Breast Imaging Reporting and Data System (BI-RADS) and the intermediate assessment processes underlying radiologists' workflow, thereby constraining their interpretability and alignment with clinical practice. We curated, to our knowledge, the largest multicenter collection of breast ultrasound images paired with structured BI-RADS descriptors, comprising 9,941 patients across 20 independent datasets. Across 14 testing datasets, IBUS demonstrated consistent generalization performance across different clinical centers and imaging conditions. Incorporating BI-RADS descriptors enabled fine-grained risk stratification, while cross-checking predicted BI-RADS grades against malignancy probabilities identified internally discordant predictions that may warrant additional clinical review. In a reader study involving eight radiologists, IBUS assistance increased diagnostic sensitivity among both junior and senior readers, with the potential of guiding radiologists to make targeted revision in risk stratification. Overall, IBUS exhibits its potential as a second-stage decision-support system that complements radiologists by providing additional risk estimates and interpretable evidence for diagnostically challenging cases. The demo video of IBUS platform is publicly available at https://github.com/zsz1997/IBUS.

Multimodal Large Models have significantly advanced automated breast ultrasound diagnosis. However, most existing frameworks utilize opaque, end-to-end paradigms prioritizing global statistical correlations over structured clinical reasoning. Consequently, these models remain susceptible to shortcut learning amid extreme real-world epidemiological imbalances, often bypassing rare but decisive malignant indicators for dominant benign patterns. To address this disconnect, we propose Latent-CURE, a novel diagnostic framework driven by asymmetric weighted chain-of-thought methodology grounded in latent space reasoning. Unlike traditional approaches, our framework constructs an implicit reasoning trajectory forcing the model to sequentially infer standardized BI-RADS morphological descriptors before converging on a final diagnosis. Furthermore, to combat the extreme scarcity of critical malignant features, we couple this architecture with a dual-asymmetric optimization strategy. By dynamically adjusting margins and weights, this strategy safeguards high-specificity malignant descriptors from being overshadowed by common benign priors. Comprehensive evaluations demonstrate that our knowledge-injected approach provides transparent clinical evidence while achieving robust, accurate diagnostic performance in imbalanced medical cohorts.

Breast ultrasound imaging is an important noninvasive method for early breast cancer diagnosis, but automatic benign/malignant classification remains challenging due to tumor heterogeneity, blurred boundaries, and data imbalance. To improve feature representation and classification accuracy, this paper proposes the Cross-Stage Attention Mixture-of-Experts Network (CSA-MoE-Net). It adopts a Cross-Stage Attention-enhanced ResNet-18 as the backbone, in which the Cross-Stage Attention module adaptively recalibrates multi-level features, thereby enhancing key tumor features and suppressing redundancy. A three-branch Mixture of Experts (MoE) Block learns complementary features from the Whole Tumor Image, Tumor Core, and Boundary, and an Adaptive Gating Network fuses them to capture morphological, textural, and contextual information. The fused features are denoted as Fused Expert Feature (FEF) in the architecture. Experiments on a balanced dataset of 2,129 breast ultrasound images show that, averaged over 20 independent runs, the model achieves an accuracy of 96.33%, precision of 94.09%, recall of 98.53%, F1-score of 96.25%, and AUC of 99.50%. Compared to the baseline ResNet-18, these metrics improve by 3.01, 0.70, 5.37, 2.98, and 5.42 percentage points, respectively. The proposed mechanism requires no invasive modification and can be seamlessly embedded into VGG-16, DenseNet-121, etc., yielding stable performance gains, thus providing reliable support for computer-aided diagnosis.