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European Radiology

, Volume 28, Issue 8, pp 3165–3175 | Cite as

Breast-density assessment with hand-held ultrasound: A novel biomarker to assess breast cancer risk and to tailor screening?

  • Sergio J. Sanabria
  • Orcun Goksel
  • Katharina Martini
  • Serafino Forte
  • Thomas Frauenfelder
  • Rahel A. Kubik-Huch
  • Marga B. Rominger
Breast

Abstract

Objectives

To assess feasibility and diagnostic accuracy of a novel hand-held ultrasound (US) method for breast density assessment that measures the speed of sound (SoS), in comparison to the ACR mammographic (MG) categories.

Methods

ACR-MG density (a=fatty to d=extremely dense) and SoS-US were assessed in the retromamillary, inner and outer segments of 106 women by two radiographers. A conventional US system was used for SoS-US. A reflector served as timing reference for US signals transmitted through the breasts. Four blinded readers assessed average SoS (m/s), ΔSoS (segment-variation SoS; m/s) and the ACR-MG density. The highest SoS and ΔSoS values of the three segments were used for MG-ACR whole breast comparison.

Results

SoS-US breasts were examined in <2 min. Mean SoS values of densities a-d were 1,421 m/s (SD 14), 1,432 m/s (SD 17), 1,448 m/s (SD 20) and 1,500 m/s (SD 31), with significant differences between all groups (p<0.001). The SoS-US comfort scores and inter-reader agreement were significantly better than those for MG (1.05 vs. 2.05 and 0.982 vs. 0.774; respectively). A strong segment correlation between SoS and ACR-MG breast density was evident (rs=0.622, p=<0.001) and increased for full breast classification (rs=0.746, p=<0.001). SoS-US allowed diagnosis of dense breasts (ACR c and d) with sensitivity 86.2 %, specificity 85.2 % and AUC 0.887.

Conclusions

Using hand-held SoS-US, radiographers measured breast density without discomfort, readers evaluated measurements with high inter-reader agreement, and SoS-US correlated significantly with ACR-MG breast-density categories.

Key Points

• The novel speed-of-sound ultrasound correlated significantly with mammographic ACR breast density categories.

• Radiographers measured breast density without women discomfort or radiation.

• SoS-US can be implemented on a standard US machine.

• SoS-US shows potential for a quantifiable, cost-effective assessment of breast density.

Keywords

Ultrasonography Mammography Breast Breast density Breast neoplasms 

Abbreviations

2D

Two-dimensional

3D

Three-dimensional

ACR

American College of Radiology

AUC

Area under the curve

BI-RADS

Breast Imaging Reporting and Data System

BMI

Body mass index

ICC

Interclass correlation coefficient

MG

Mammography

p

Probability value

PACS

Picture Archiving and Communication System

ROC

Receiver operating characteristic

rs

Spearman’s rank correlation coefficients

SoS

Speed of sound

US

Ultrasound

ΔSoS

Segment-variation of SoS, heterogeneity

Notes

Acknowledgements

The authors thank Milka Cebic-Paunovic, Radiology Technologist and Flora Kelecsenyi, RT for their valuable contributions.

Funding

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Prof. Dr. med. Marga B. Rominger.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• prospective

• case-control study

• performed at one institution

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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Sergio J. Sanabria
    • 1
  • Orcun Goksel
    • 1
  • Katharina Martini
    • 2
  • Serafino Forte
    • 3
  • Thomas Frauenfelder
    • 2
  • Rahel A. Kubik-Huch
    • 3
  • Marga B. Rominger
    • 2
  1. 1.Computer-assisted Applications in MedicineETH ZurichZürichSwitzerland
  2. 2.Institute of Diagnostic and Interventional RadiologyUniversity Hospital ZurichZürichSwitzerland
  3. 3.Department of RadiologyKantonsspital BadenBadenSwitzerland

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