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Breast Cancer Assessment With Pulse-Echo Speed of Sound Ultrasound From Intrinsic Tissue Reflections


Ruby, Lisa, MD*; Sanabria, Sergio J., PhD*,†; Martini, Katharina, MD*; Dedes, Konstantin J., MD; Vorburger, Denise, MD; Oezkan, Ece, PhD; Frauenfelder, Thomas, MD*; Goksel, Orcun, PhD; Rominger, Marga B., MD*

doi: 10.1097/RLI.0000000000000553
Original Articles

Purpose The aim of this study was to differentiate malignant and benign solid breast lesions with a novel ultrasound (US) technique, which measures speed of sound (SoS) using standard US transducers and intrinsic tissue reflections and scattering (speckles) as internal reference.

Materials and Methods This prospective, institutional review board–approved, Health Insurance Portability and Accountability Act-compliant prospective comparison study was performed with prior written informed consent from 20 women. Ten women with histological proven breast cancer and 10 with fibroadenoma were measured. A conventional US system with a linear probe was used for SoS-US (SonixTouch; Ultrasonix, Richmond, British Columbia, Canada). Tissue speckle reflections served as a timing reference for the US signals transmitted through the breasts. Relative phase inconsistencies were detected using plane wave measurements from different angular directions, and SoS images with 0.5-mm resolution were generated using a spatial domain reconstruction algorithm. The SoS of tumors were compared with the breast density of a larger cohort of 106 healthy women.

Results Breast lesions show focal increments ΔSoS (meters per second) with respect to the tissue background. Peak ΔSoS values were evaluated. Breast carcinoma showed significantly higher ΔSoS than fibroadenomas ([INCREMENT]SoS > 41.64 m/s: sensitivity, 90%; specificity, 80%; area under curve, 0.910) and healthy breast tissue of different densities (area under curve, 0.938; sensitivity, 90%; specificity, 96.5%). The lesion localization in SoS-US images was consistent with B-mode imaging and repeated SoS-US measurements were reproducible.

Conclusions Using SoS-US, based on conventional US and tissue speckles as timing reference, breast carcinoma showed significantly higher SoS values than fibroadenoma and healthy breast tissue of different densities. The SoS presents a promising technique for differentiating solid breast lesions.

From the *Institute of Diagnostic and Interventional Radiology, University Hospital Zurich;

Computer-Assisted Applications in Medicine, ETH Zurich; and

Breast Cancer Center, Comprehensive Cancer Center Zurich, University Hospital of Zurich, Zurich, Switzerland.

Received for publication November 26, 2018; and accepted for publication, after revision, January 13, 2019.

Lisa Ruby and Sergio J. Sanabria both contributed equally to the manuscript.

Conflicts of interest and sources of funding: This project has been generously supported by a donation from Hans-Peter-Wild to the University Hospital Zurich Foundation. Sergio Sanabria was funded by the ETH Pioneer Fellowship.

All authors contributed substantially to the conception and design, acquisition of data, or analysis and interpretation of data, as well as drafting the article or revising it critically for important intellectual content.

Final approval of the version to be published.

Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Correspondence to: Marga B. Rominger, MD, Institute of Diagnostic and Interventional Radiology, University Hospital Zürich, Rämistrasse 100, 8091 Zürich. E-mail:

Online date: March 26, 2019

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