Morphology-enhanced CAM-guided SAM for weakly supervised breast lesion segmentation

Ultrasound imaging is vital for the early detection of breast cancer, where accurate lesion segmentation supports clinical diagnosis and treatment planning. However, existing deep learning-based methods rely on pixel-level annotations, which are costly and labor-intensive to obtain. This study presents a weakly supervised framework for breast lesion segmentation in ultrasound images. The framework combines morphological enhancement with Class Activation Map (CAM)-guided lesion localization and utilizes the Segment Anything Model (SAM) for refined segmentation without pixel-level labels. By adopting a lightweight region synthesis strategy and relying solely on SAM inference, the proposed approach substantially reduces model complexity and computational cost while maintaining high segmentation accuracy. Experimental results on the BUSI dataset show that our method achieves a Dice coefficient of 0.7063 under five-fold cross-validation and outperforms several fully supervised models in Hausdorff distance metrics. These results demonstrate that the proposed framework effectively balances segmentation accuracy, computational efficiency, and annotation cost, offering a practical and low-complexity solution for breast ultrasound analysis. The code for this study is available at: https://github.com/YueXin18/MorSeg-CAM-SAM-Segmentation.