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A Multicentric Comparison of Apparent Diffusion Coefficient Mapping and the Kaiser Score in the Assessment of Breast Lesions
- Source :
- Investigative radiology. 56(5)
- Publication Year :
- 2020
-
Abstract
- In this multicentric study, individual patient data from 3 different centers were analyzed. Consecutive patients receiving standardized multiparametric breast magnetic resonance imaging for standard nonscreening indications were included. At each center, 2 experienced radiologists with more than 5 years of experience retrospectively interpreted the examinations in consensus and applied the KS to every histologically verified lesion. The corresponding mean ADC of each lesion was measured using a Wielema type 4 region of interest. According to established methods, the KS and ADC were combined, yielding the KS+ score. Diagnostic accuracy was evaluated by the area under the receiver operating characteristics curve (AUROC) and compared between the KS, ADC, and KS+ (DeLong test). Likewise, the potential to help avoid unnecessary biopsies was compared between the KS, ADC, and KS+ based on established high sensitivity thresholds (McNemar test).A total of 450 lesions in 414 patients (mean age, 51.5 years; interquartile range, 42-60.8 years) were included, with 219 lesions being malignant (48.7%; 95% confidence interval [CI], 44%-53.4%). The performance of the KS (AUROC, 0.915; CI, 0.886-0.939) was significantly better than that of the ADC (AUROC, 0.848; CI, 0.811-0.880; P0.001). The largest difference between these parameters was observed when assessing subcentimeter lesions (AUROC, 0.909 for KS; CI, 0.849-0.950 vs 0.811 for ADC; CI, 0.737-0.871; P = 0.02).The use of the KS+ (AUROC, 0.918; CI, 0.889-0.942) improved the performance slightly, but without any significant difference relative to a single KS or ADC reading (P = 0.64).When applying high sensitivity thresholds for avoiding unnecessary biopsies, the KS and ADC achieved equal sensitivity (97.7% for both; cutoff values,4 for KS and ≤1.4 × 10-3 mm2/s for ADC). However, the rate of potentially avoidable biopsies was higher when using the KS (specificity: 65.4% for KS vs 32.9% for ADC; P0.0001). The KS was superior to the KS+ in avoiding unnecessary biopsies.Both the KS and ADC may be used to distinguish benign from malignant breast lesions. However, KS proved superior in this task including, most of all, when assessing small lesions less than 1 cm. Using the KS may avoid twice as many unnecessary biopsies, and the combination of both the KS and ADS does not improve diagnostic performance.
- Subjects :
- Breast Neoplasms
Sensitivity and Specificity
030218 nuclear medicine & medical imaging
Lesion
Diagnosis, Differential
03 medical and health sciences
0302 clinical medicine
McNemar's test
Interquartile range
Region of interest
medicine
Effective diffusion coefficient
Humans
Radiology, Nuclear Medicine and imaging
Breast
Retrospective Studies
Receiver operating characteristic
business.industry
General Medicine
Patient data
Middle Aged
Confidence interval
body regions
Diffusion Magnetic Resonance Imaging
ROC Curve
Female
medicine.symptom
Nuclear medicine
business
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 15360210
- Volume :
- 56
- Issue :
- 5
- Database :
- OpenAIRE
- Journal :
- Investigative radiology
- Accession number :
- edsair.doi.dedup.....41e4be7cb48f57b2aff435a629c3fa18