Send to

Choose Destination
Eur Radiol. 2018 Aug;28(8):3165-3175. doi: 10.1007/s00330-017-5287-9. Epub 2018 Mar 19.

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

Author information

Computer-assisted Applications in Medicine, ETH Zurich, Sternwartstrasse 7, 8092, Zürich, Switzerland.
Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091, Zürich, Switzerland.
Department of Radiology, Kantonsspital Baden, Im Ergel 1, 5404, Baden, Switzerland.
Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091, Zürich, Switzerland.



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.


• 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.


Breast; Breast density; Breast neoplasms; Mammography; Ultrasonography

[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Springer
Loading ...
Support Center