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To better exploit the real-time advantages of ultrasound and more conducive to clinical application, we proposed a whole-lesion-aware network based on freehand ultrasound video (WAUVE) scanning in an arbitrary direction for predicting overall breast cancer risk score.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>The WAUVE was developed using 2912 videos (2912 lesions) of 2771 patients retrospectively collected from May 2020 to August 2022 in two hospitals. We compared the diagnostic performance of WAUVE with static 2D-ResNet50 and dynamic TimeSformer models in the internal validation set. Subsequently, a dataset comprising 190 videos (190 lesions) from 175 patients prospectively collected from December 2022 to April 2023 in two other hospitals, was used as an independent external validation set. A reader study was conducted by four experienced radiologists on the external validation set. We compared the diagnostic performance of WAUVE with the four experienced radiologists and evaluated the auxiliary value of model for radiologists.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>The WAUVE demonstrated superior performance compared to the 2D-ResNet50 model, while similar to the TimeSformer model. In the external validation set, WAUVE achieved an area under the receiver operating characteristic curve (AUC) of 0.8998 (95% CI\u2009=\u20090.8529\u20130.9439), and showed a comparable diagnostic performance to that of four experienced radiologists in terms of sensitivity (97.39% vs. 98.48%, <jats:italic>p<\/jats:italic>\u2009=\u20090.36), specificity (49.33% vs. 50.00%, <jats:italic>p<\/jats:italic>\u2009=\u20090.92), and accuracy (78.42% vs.79.34%, <jats:italic>p<\/jats:italic>\u2009=\u20090.60). With the WAUVE model assistance, the average specificity of four experienced radiologists was improved by 6.67%, and higher consistency was achieved (from 0.807 to 0.838).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>The WAUVE based on non-standardized ultrasound scanning demonstrated excellent performance in breast cancer assessment which yielded outcomes similar to those of experienced radiologists, indicating the clinical application of the WAUVE model promising.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s40644-025-00892-y","type":"journal-article","created":{"date-parts":[[2025,6,16]],"date-time":"2025-06-16T16:11:27Z","timestamp":1750090287000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Whole-lesion-aware network based on freehand ultrasound video for breast cancer assessment: a prospective multicenter study"],"prefix":"10.1186","volume":"25","author":[{"given":"Jie","family":"Han","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanjing","family":"Gao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling","family":"Huo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaozheng","family":"Xie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengsu","family":"Xiao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nan","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meng","family":"Lei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quanlin","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinyi","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuzhen","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3317-4966","authenticated-orcid":false,"given":"Binghui","family":"Tang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1739-2621","authenticated-orcid":false,"given":"Liwei","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9556-9192","authenticated-orcid":false,"given":"Qingli","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7682-0433","authenticated-orcid":false,"given":"Yong","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,6,16]]},"reference":[{"key":"892_CR1","doi-asserted-by":"publisher","first-page":"229","DOI":"10.3322\/caac.21834","volume":"74","author":"F Bray","year":"2024","unstructured":"Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. 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The retrospective study was approved by Ethics Committee of National Cancer Center\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (No. 22\/386-3588) with a waiver granted for the requirement of informed consent. The prospective study was approved by Ethics Committee of National Cancer Center\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (No. 21\/328-2999), and informed consent was obtained from each patient or their guardian before the US examination.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"75"}}