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.
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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
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Acknowledgements
The authors thank Milka Cebic-Paunovic, Radiology Technologist and Flora Kelecsenyi, RT for their valuable contributions.
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The scientific guarantor of this publication is Prof. Dr. med. Marga B. Rominger.
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One of the authors has significant statistical expertise.
No complex statistical methods were necessary for this paper.
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Written informed consent was obtained from all subjects (patients) in this study.
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• prospective
• case-control study
• performed at one institution
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Sanabria, S.J., Goksel, O., Martini, K. et al. Breast-density assessment with hand-held ultrasound: A novel biomarker to assess breast cancer risk and to tailor screening?. Eur Radiol 28, 3165–3175 (2018). https://doi.org/10.1007/s00330-017-5287-9
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DOI: https://doi.org/10.1007/s00330-017-5287-9