A Multicentric Comparison of Apparent Diffusion Coefficient Mapping and the Kaiser Score in the Assessment of Breast Lesions

Abstract

Objective: We sought to compare the diagnostic performance of apparent diffusion coefficient (ADC) mapping with the Kaiser score (KS) to distinguish benign from malignant breast lesions and to assess the potential of this approach to help avoid unnecessary biopsies. Materials and Methods: 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). Results: 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; P < 0.001). 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 Â 10 −3 mm 2 /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; P < 0.0001). The KS was superior to the KS+ in avoiding unnecessary biopsies. Conclusions: 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.

A Comparative Assessment of MR BI-RADS 4 Breast Lesions With Kaiser Score and Apparent Diffusion Coefficient Value

“…More critical evaluation will be considered in follow-up work, including studying as many systems, protocols, and centers as we possibly can. Analogous to Dietzel et al (10), our results showed that the sensitivity with Kaiser score+ also decreased. The missed lesion was a rare finding that exhibited atypical morphological patterns of a malignant lesion.…”

“…As a clinical decision rule, Kaiser score (a clinical scoring system) incorporating several BI-RADS diagnostic criteria has demonstrated robust performance in the assessment of breast lesions with excellent sensitivity and specificity (8)(9)(10)(11)(12)(13), which could potentially avoid unnecessary biopsies. The Kaiser score consists of 11 rating categories ranging from 1 to 11, with each category corresponding to a distinct likelihood of malignancy (13).…”

Supplemental screening using breast MRI in women with mammographically dense breasts

“…These findings are in line with prior reports applying the same score in high-risk patients [17], lesions presenting as mammographic microcalcifications [18] and suspicious BI-RADS 4 lesions only visible on MRI [19]. Notably, according to a multicentric analysis, the Kaiser score seems to be better suited to this task than the most promising quantitative imaging biomarker in breast imaging, the Apparent Diffusion Coefficient derived from Diffusion Weighted Imaging [20]. These findings suggest the clinical application of the Kaiser score as an effective tool to avoid unnecessary biopsies at a high level of evidence.…”

Diagnostic performance of the Kaiser score for characterizing lesions on breast MRI with comparison to a multiparametric classification system

“…The interobserver agreement for the Kaiser score varied between the earlier studies, ranging from fair to almost perfect agreement [14,15,[17][18][19]22]. This indicates that, while the Kaiser score is simple and easy to use, there may be some challenging aspects.…”