Diagnostic Performance of Universal-Learning Ultrasound AI Across Multiple Organs and Tasks: the UUSIC25 Challenge

IMPORTANCE: Current ultrasound AI remains fragmented into single-task tools, limiting clinical utility compared to versatile modern ultrasound systems. OBJECTIVE: To evaluate the diagnostic accuracy and efficiency of single general-purpose deep learning models for multi-organ classification and segmentation. DESIGN: The Universal UltraSound Image Challenge 2025 (UUSIC25) involved developing algorithms on 11,644 images (public/private). Evaluation used an independent, multi-center test set of 2,479 images, including data from a center completely unseen during training to assess generalization. OUTCOMES: Diagnostic performance (Dice Similarity Coefficient [DSC]; Area Under the Receiver Operating Characteristic Curve [AUC]) and computational efficiency (inference time, GPU memory). RESULTS: Of 15 valid algorithms, the top model (SMART) achieved a macro-averaged DSC of 0.854 across 5 segmentation tasks and AUC of 0.766 for binary classification. Models showed high capability in segmentation (e.g., fetal head DSC: 0.942) but variability in complex tasks subject to domain shift. Notably, in breast cancer molecular subtyping, the top model's performance dropped from AUC 0.571 (internal) to 0.508 (unseen external center), highlighting generalization challenges. CONCLUSIONS: General-purpose AI models achieve high accuracy and efficiency across multiple tasks using a single architecture. However, performance degradation on unseen data suggests domain generalization is critical for future clinical deployment.