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



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.


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.


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.


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.


Ultrasonography Mammography Breast Breast density Breast neoplasms 







American College of Radiology


Area under the curve


Breast Imaging Reporting and Data System


Body mass index


Interclass correlation coefficient




Probability value


Picture Archiving and Communication System


Receiver operating characteristic


Spearman’s rank correlation coefficients


Speed of sound




Segment-variation of SoS, heterogeneity



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


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

Compliance with ethical standards


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.


• 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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