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Application of Ultrasound in Cancer Diagnosis and Treatment

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A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Methods and Technologies Development".

Deadline for manuscript submissions: closed (1 April 2026) | Viewed by 8185

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Special Issue Editors

Prof. Dr. Radu Ion Badea

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Guest Editor

1. Department of Medical Imaging, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
2. “Prof. Dr. O. Fodor” Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania
3. The Academy of Romanian Scientists, 050044 Bucharest, Romania
Interests: gastroenterology; ultrasonography; contrast; elastography; Doppler
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Adrian Bartoș

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Guest Editor

1. Institute of Advanced Studies in Science and Technology, Babeș-Bolyai University, Cluj-Napoca, Romania
2. Faculty of Medical and Health Sciences, Babeș-Bolyai University, Cluj-Napoca, Romania
3. Regina Maria Hospital, Cluj-Napoca, Romania
Interests: intraoperative ultrasound; interventional ultrasound; surgical oncology; robotic surgery; laparoscopic surgery

Special Issue Information

Dear Colleagues,

Ultrasound technology has revolutionized the landscape of cancer diagnosis and treatment, offering a non-invasive, cost-effective, and widely accessible approach for clinicians and patients alike. By utilizing high-frequency sound waves, ultrasound enables real-time imaging of soft tissue structures, allowing for the detection and characterization of tumors that may not be visible on traditional x-rays. Its high-resolution capabilities together with the use of contrast agents facilitate precise measurement of tumor size, assessment of vascularity, and differentiation between benign and malignant lesions.

In clinical practice, ultrasound plays a pivotal role in guiding biopsies, ensuring accurate sampling and minimizing procedural risks. Doppler ultrasound, contrast-enhanced ultrasound, and elastography further enhancediagnostic accuracy, helping to distinguish malignant from benign tissue. Beyond diagnosis, therapeutic applications such as High-Intensity Focused Ultrasound (HIFU), intraoperative ultrasound-guided surgery, ultrasound-guided tumor ablations, and ultrasound-guided drainages provide promising non-invasive treatment options, including in the field of minimally invasive surgery. As research advances, ultrasound continues to expand its utility in oncology, supporting early detection, personalized treatment strategies, and improved patient outcomes. This Special Issue highlights the latest developments and future directions in the application of ultrasound for cancer care.

Prof. Dr. Radu Ion Badea
Prof. Dr. Adrian Bartoș
Guest Editors

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Keywords

contrast-enhanced
ultrasound
elastography
intraoperative ultrasound
ultrasound-guided procedures
minimally invasive ultrasound
ultrasound-guided liver resections
ultrasound-guided tumoral ablations
liver tumors

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Published Papers (5 papers)

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Research

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16 pages, 1895 KB

Open AccessArticle

The Value of Multimodal Ultrasound in Differentiating Benign from Malignant Cytologically Indeterminate Thyroid Nodules

by Rong Yang, Yanfang Wang, Guo Chen, Xiaorong Lv, Yuanqing Zhang and Fang Nie

Cancers 2026, 18(7), 1071; https://doi.org/10.3390/cancers18071071 - 25 Mar 2026

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Abstract

Aim: To evaluate the diagnostic value of conventional ultrasound (CUS) and contrast-enhanced ultrasound (CEUS) features in differentiating benign from malignant Bethesda III/IV thyroid nodules, and to identify independent predictors of malignancy. Methods: We retrospectively analyzed 164 surgically confirmed Bethesda III/IV thyroid nodules. CUS and CEUS features were evaluated by two experienced radiologists blinded to pathological outcomes. Univariate analysis compared features between benign and malignant groups. Multivariate logistic regression was used to identify independent predictors. Diagnostic models were constructed based on CUS alone, CEUS alone, and their combination, with performance evaluated using receiver operating characteristic (ROC) curve analysis. The area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each model. Results: The malignancy rate was 48.8% (80/164). Multivariate analysis identified microcalcifications (OR = 4.815, p < 0.001), aspect ratio >1 (OR = 2.499, p = 0.028), and irregular shape (OR = 2.465, p = 0.035) as independent risk factors, while older age (OR = 0.926 per year, p < 0.001) was protective. The CUS model achieved an AUC of 0.815 with high sensitivity (91.3%) and NPV (87.7%). The CEUS model performed poorly (AUC = 0.609). The combined model (AUC = 0.823) showed no significant improvement over CUS alone (p > 0.05). Physician subjective diagnosis based on CEUS TI-RADS yielded an AUC of 0.775. Conclusions: Conventional ultrasound features provide good diagnostic value for Bethesda III/IV nodules, with high sensitivity and NPV suitable for clinical screening. The addition of CEUS offered limited incremental benefit in this specific population, suggesting that the diagnostic value of CEUS for differentiating benign from malignant cytologically indeterminate thyroid nodules (ITNs) may be limited. Full article

(This article belongs to the Special Issue Application of Ultrasound in Cancer Diagnosis and Treatment)

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13 pages, 3297 KB

Open AccessArticle

Effect of a Real-Time Artificial Intelligence-Assisted Ultrasound System on BI-RADS C4 Breast Lesions Based on Breast Density

by Jeeyeon Lee, Won Hwa Kim, Jaeil Kim, Byeongju Kang, Joon Suk Moon, Hye Jung Kim, Soo Jung Lee, In Hee Lee and Ho Yong Park

Cancers 2026, 18(3), 536; https://doi.org/10.3390/cancers18030536 - 6 Feb 2026

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Abstract

Background: Artificial intelligence-based computer-aided diagnosis (AI-CAD) systems are increasingly used in breast ultrasonography; however, their diagnostic performance may vary with breast density. Given that dense breasts are highly prevalent among Asian women, understanding this relationship is essential for optimizing AI-assisted imaging strategies. Therefore, this study aims to evaluate the effect of breast density on the diagnostic accuracy of an AI-CAD ultrasound system in BI-RADS category 4 (C4) breast lesions. Methods: Overall, 110 consecutive BI-RADS C4 lesions were reviewed between January and December 2023. An AI-CAD ultrasound system automatically assigned BI-RADS categories and calculated the probability of malignancy (POM) using static ultrasound images. Histopathology served as the reference standard, with atypia and malignancy combined into a non-benign category. Diagnostic performance—including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy—was analyzed based on breast density (BI-RADS B–D), determined using AI-assisted mammography. Results: Overall, the sensitivity and NPV were 81.3% and 87.5%, respectively, while the specificity and PPV were lower at 53.8% and 41.9%. All diagnostic performance metrics improved with increasing breast density. In the density D category, sensitivity (92.3%), specificity (61.5%), NPV (96.0%), and accuracy (69.2%) were highest. Additionally, concordance between AI-assigned BI-RADS categories and histopathologic diagnoses increased with density (B: 50.0%, C: 57.5%, D: 67.3%). Across all density groups, non-benign lesions consistently demonstrated higher POM values. Conclusions: Breast density significantly affects the diagnostic performance of AI-CAD ultrasound in BI-RADS C4 lesions. The AI system demonstrates higher accuracy and concordance in dense breasts, suggesting more consistent lesion interpretation in high-density environments. These findings highlight the potential utility of AI-assisted ultrasound as a diagnostic adjunct, particularly for Asian women, who commonly have dense breast composition. Further multicenter, real-time validation studies are warranted to validate these findings. Full article

(This article belongs to the Special Issue Application of Ultrasound in Cancer Diagnosis and Treatment)

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Review

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38 pages, 988 KB

Open AccessReview

The Potential and Challenges of Focused Ultrasound-Mediated Therapies in the Management of Liver and Biliary Tract Cancers

by Mira Florea, Viorica Nagy, Paul Milan Kubelac, Adrian Bartos, Delia Dima, Rares Potcoava Buiga and Monica Lupsor-Platon

Cancers 2026, 18(10), 1654; https://doi.org/10.3390/cancers18101654 (registering DOI) - 20 May 2026

Abstract

Focused ultrasound (FUS)-mediated therapies have evolved with the advent of modern ultrasound-guided technology and MRI imaging, moving from their initial use as thermal ablation to a multifunctional platform for thermal and non-thermal ablation, immunomodulation, and targeted drug delivery. This narrative review explores the potential, limitations, and challenges of ablative high-intensity focused ultrasound (HIFU) therapies: HIFU thermal ablation and non-thermal ablation, histotripsy, as well as non-ablative low-intensity focused ultrasound (LIFU) applications in the management of hepatobiliary cancers. HIFU and histotripsy are reviewed as alternative or complementary treatment options in liver tumors, as well as their potential as bridging therapy. Histotripsy is addressed as a theranostic tool, not only by combining ablation with real-time ultrasound imaging guidance, but also by integrating it with sonobiopsy. It facilitates a liquid sonobiopsy of the ablated tumor by releasing intact tumor antigens and damage-associated molecular patterns, leading to potential molecular profiling. LIFU-induced targeted drug delivery (sono-chemotherapy), sonodynamic therapy, radiosensitization, immunomodulation of the immunosuppressive tumor microenvironment (sono-immunotherapy), and the potential to enhance the effect of immune checkpoint inhibitors in these malignancies are discussed. Since FUS-assisted procedures exhibit dual actions through therapeutic functionality associated with intra- and post-procedural ultrasound imaging guidance, they could have value as a theranostic tool in hepatobiliary interventional oncology. Although promising, the available clinical evidence for FUS-mediated therapies in hepatobiliary malignancies consists predominantly of early-stage feasibility studies, retrospective observational cohorts, and non-randomized comparative analyses. Further studies focused on standardized protocols, validation through large-scale, multicenter, prospective randomized clinical trials comparing FUS-based therapies with established treatments, and long-term follow-up of oncological efficacy could define their future role in multimodal oncological strategies. Full article

(This article belongs to the Special Issue Application of Ultrasound in Cancer Diagnosis and Treatment)

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33 pages, 3149 KB

Open AccessReview

High-Intensity Focused Ultrasound in Dermatology: A Review with Emphasis on Skin Cancer Management and Prevention

by Bartosz Woźniak, Piotr Sobolewski, Natalia Sauer, Mateusz Koper and Jacek Calik

Cancers 2025, 17(21), 3518; https://doi.org/10.3390/cancers17213518 - 31 Oct 2025

Cited by 1 | Viewed by 5129

Abstract

High-intensity focused ultrasound (HIFU) has recently emerged as a novel non-invasive treatment modality in dermatology, offering precise ablation of cutaneous lesions with minimal damage to surrounding tissue. Originally developed for deep-seated tumors, dermatological HIFU platforms operating at ~20 MHz enable submillimeter-scale treatment of thermal or mechanical injuries localized to the epidermis and superficial dermis, making them suitable for managing benign, premalignant, and malignant skin conditions. This review outlines the mechanistic basis of HIFU—including thermal coagulation, acoustic cavitation, and immunomodulatory effects—and presents the current evidence for its efficacy in treating actinic keratoses and basal cell carcinomas (BCCs), where early studies report clearance rates of 70–97% and excellent cosmetic outcomes. Compared to conventional therapies such as surgery, photodynamic therapy, or cryotherapy, HIFU offers reduced procedural pain, faster healing, and the ability to treat multiple lesions in a single session. Its role in field cancerization and potential utility in prophylaxis for high-risk skin areas are also explored. While promising, long-term oncologic outcomes and standardized treatment protocols remain under investigation. HIFU represents a significant advancement in non-invasive skin cancer management, aligning oncologic efficacy with patient-centered care. Full article

(This article belongs to the Special Issue Application of Ultrasound in Cancer Diagnosis and Treatment)

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14 pages, 588 KB

Open AccessSystematic Review

Application of Transthoracic and Endobronchial Elastography—A Systematic Review

by Christian Kildegaard, Rune W. Nielsen, Christian B. Laursen, Ariella Denize Nielsen, Amanda D. Juul, Tai Joon An, Dinesh Addala and Casper Falster

Cancers 2026, 18(2), 190; https://doi.org/10.3390/cancers18020190 - 7 Jan 2026

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Abstract

Introduction: Ultrasound elastography is increasingly used across medical imaging, yet its role in thoracic disease remains poorly defined. While both transthoracic ultrasonography (TUS) and endobronchial ultrasound (EBUS) offer real-time assessment of pleural and pulmonary structures, the diagnostic and clinical value of elastography in this context remains uncertain. Materials and Method: A systematic search of MEDLINE, EMBASE, and the Cochrane Library was conducted according to PRISMA guidelines (April 2023; updated January 2025). Original studies evaluating transthoracic or endobronchial elastography for pleural or pulmonary conditions were included. Data extraction and quality assessment were performed independently by three reviewers, with QUADAS-2 used to evaluate risk of bias. Results: Thirty studies met inclusion criteria. Twenty-eight evaluated TUS elastography and two examined EBUS. Shear wave elastography was most frequently applied, particularly for differentiating malignant from benign pleural effusion or subpleural lesions. Surface wave elastography demonstrated consistently higher stiffness values in patients with interstitial lung disease compared with healthy controls, correlating with radiological and functional disease severity. Elastography-guided pleural biopsy improved diagnostic yield compared with conventional ultrasound-guided biopsy. Overall, substantial methodological variation existed among scanning techniques, elastography modalities, reporting methods, and diagnostic thresholds, limiting cross-study comparison. Conclusions: Ultrasound elastography shows promise for evaluating pleural effusion and pulmonary lesions, procedural guidance, and interstitial lung disease possibly improving diagnostic possibilities with bedside evaluation and reducing patient exposure to radiation. However, methodological variation and limited high-quality evidence preclude clinical implementation. Standardized acquisition protocols and multicentre validation studies are necessary to define its diagnostic utility in thoracic imaging. Full article

(This article belongs to the Special Issue Application of Ultrasound in Cancer Diagnosis and Treatment)

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