BackgroundBreast cancer is one of the most serious diseases threatening women’s health. Early screening based on ultrasound can help to detect and treat tumours in the early stage. However, due to the lack of radiologists with professional skills, ultrasound-based breast cancer screening has not been widely used in rural areas. Computer-aided diagnosis (CAD) technology can effectively alleviate this problem. Since breast ultrasound (BUS) images have low resolution and speckle noise, lesion segmentation, which is an important step in CAD systems, is challenging.ResultsTwo datasets were used for evaluation. Dataset A comprises 500 BUS images from local hospitals, while dataset B comprises 205 open-source BUS images. The experimental results show that the proposed method outperformed its related classic segmentation methods and the state-of-the-art deep learning model RDAU-NET. Its accuracy (Acc), Dice similarity coefficient (DSC) and Jaccard index (JI) reached 96.25%, 78.4% and 65.34% on dataset A, and its Acc, DSC and sensitivity reached 97.96%, 86.25% and 88.79% on dataset B, respectively.ConclusionsWe proposed an adaptive morphological snake based on marked watershed (AMSMW) algorithm for BUS image segmentation. It was proven to be robust, efficient and effective. In addition, it was found to be more sensitive to malignant lesions than benign lesions.MethodsThe proposed method consists of two steps. In the first step, contrast limited adaptive histogram equalization (CLAHE) and a side window filter (SWF) are used to preprocess BUS images. Lesion contours can be effectively highlighted, and the influence of noise can be eliminated to a great extent. In the second step, we propose adaptive morphological snake (AMS). It can adjust the working parameters adaptively according to the size of the lesion. Its segmentation results are combined with those of the morphological method. Then, we determine the marked area and obtain candidate contours with a marked watershed (MW). Finally, the best lesion contour is chosen by the maximum average radial derivative (ARD).