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The Kaiser score reliably excludes malignancy in benign contrast-enhancing lesions classified as BI-RADS 4 on breast MRI high-risk screening exams
- Source :
- European Radiology
- Publication Year :
- 2020
- Publisher :
- Springer Science and Business Media LLC, 2020.
-
Abstract
- Objectives MRI is an integral part of breast cancer screening in high-risk patients. We investigated whether the application of the Kaiser score, a clinical decision-support tool, may be used to exclude malignancy in contrast-enhancing lesions classified as BI-RADS 4 on breast MRI screening exams. Methods This retrospective study included 183 consecutive, histologically proven, suspicious (MR BI-RADS 4) lesions detected within our local high-risk screening program. All lesions were evaluated according to the Kaiser score for breast MRI by three readers blinded to the final histopathological diagnosis. The Kaiser score ranges from 1 (lowest, cancer very unlikely) to 11 (highest, cancer very likely) and reflects increasing probabilities of malignancy, with scores greater than 4 requiring biopsy. Receiver operating characteristic (ROC) curve analysis was used to evaluate diagnostic accuracy. Results There were 142 benign and 41 malignant lesions, diagnosed in 159 patients (mean age, 43.6 years). Median Kaiser scores ranged between 2 and 5 in benign and 7 and 8 in malignant lesions. For all lesions, the Kaiser score’s accuracy, represented by the area under the curve (AUC), ranged between 86.5 and 90.2. The sensitivity of the Kaiser score was high, between 95.1 and 97.6% for all lesions, and was best in mass lesions. Application of the Kaiser score threshold for malignancy (≤ 4) could have potentially avoided 64 (45.1%) to 103 (72.5%) unnecessary biopsies in 142 benign lesions previously classified as BI-RADS 4. Conclusions The use of Kaiser score in high-risk MRI screening reliably excludes malignancy in more than 45% of contrast-enhancing lesions classified as BI-RADS 4. Key Points • The Kaiser score shows high diagnostic accuracy in identifying malignancy in contrast-enhancing lesions in patients undergoing high-risk screening for breast cancer. • The application of the Kaiser score may avoid > 45% of unnecessary breast biopsies in high-risk patients. • The Kaiser score aids decision-making in high-risk breast cancer MRI screening programs.
- Subjects :
- Adult
Image-Guided Biopsy
Risk
medicine.medical_specialty
Breast Neoplasms
BI-RADS
Decision support systems
Malignancy
Sensitivity and Specificity
030218 nuclear medicine & medical imaging
Clinical
Young Adult
03 medical and health sciences
Breast cancer screening
Breast cancer
Magnetic resonance imaging
0302 clinical medicine
medicine
Humans
Breast MRI
Radiology, Nuclear Medicine and imaging
Breast
Early Detection of Cancer
Aged
Probability
Retrospective Studies
Neuroradiology
Aged, 80 and over
medicine.diagnostic_test
Receiver operating characteristic
business.industry
Carcinoma
Cancer
General Medicine
Middle Aged
Decision Support Systems, Clinical
medicine.disease
Carcinoma, Intraductal, Noninfiltrating
ROC Curve
Area Under Curve
030220 oncology & carcinogenesis
Screening
Female
Radiology
business
Subjects
Details
- ISSN :
- 14321084 and 09387994
- Volume :
- 30
- Database :
- OpenAIRE
- Journal :
- European Radiology
- Accession number :
- edsair.doi.dedup.....22a68b7756726228cb1b360e3ab32307