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Zhang B, Guo Z, Lei Z, Liang W, Chen X. Kaiser score diagnosis of breast MRI lesions: Factors associated with false-negative and false-positive results. Eur J Radiol 2024; 178:111641. [PMID: 39053308 DOI: 10.1016/j.ejrad.2024.111641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 07/05/2024] [Accepted: 07/19/2024] [Indexed: 07/27/2024]
Abstract
PURPOSE We sought factors associated with false-negative and false-positive results in the diagnosis of breast lesions using the Kaiser score (KS) on breast magnetic resonance imaging (MRI). METHODS We retrospectively analyzed 1058 patients with 1058 breast lesions who underwent preoperative breast MRI with successful histopathologic results. Two radiologists assessed each lesion according to KS criteria, and clinicopathologic features and MRI findings were analyzed. Multivariate regression analysis was conducted to identify factors associated with false-negative and false-positive KS results. RESULTS Of the 1058 lesions, 859 were malignant and 199 were benign. Particularly high misdiagnosis rates were observed for intraductal papilloma, inflammatory lesion, and mucinous carcinoma. For breast cancer, KS yielded 821 (95.6 %) true-positive and 38 (4.4 %) false-negative results. Multivariate analysis showed that smaller lesion size (≤1 cm) (OR, 3.698; 95 %CI, 1.430-9.567; p = 0.007), absence of ipsilateral breast hypervascularity (OR, 3.029; 95 %CI, 1.370-6.693; p = 0.006), and presence of hyperintensity on T2WI (OR, 2.405; 95 %CI, 1.121-5.162; p = 0.024) were significantly associated with false-negative breast cancer results. For benign lesions, KS yielded 141 (70.9 %) true-negative and 58 (29.1 %) false-positive results. Multivariate regression analysis revealed that non-mass enhancement lesions (OR, 4.660; 95 %CI, 2.018-10.762; p<0.001), moderate/high background parenchymal enhancement (OR, 2.402; 95 %CI, 1.180-4.892; p = 0.016), and the presence of hyperintensity on T2WI (OR, 2.986; 95 %CI, 1.386-6.433; p = 0.005) were significantly associated with false-positive KS results. CONCLUSION Several clinicopathologic and MRI features influence the accuracy of KS diagnosis. Understanding these factors may facilitate appropriate use of KS and guide alternative diagnostic approaches, ultimately improving diagnostic accuracy in the evaluation of breast lesions.
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Affiliation(s)
- Bing Zhang
- Department of Radiology, Second Affiliated Hospital of Xi'an Jiao tong University, Xi'an, Shaanxi, China
| | - Zhuanzhuan Guo
- Department of Radiology, Second Affiliated Hospital of Xi'an Jiao tong University, Xi'an, Shaanxi, China
| | - Zhe Lei
- Department of Radiology, Second Affiliated Hospital of Xi'an Jiao tong University, Xi'an, Shaanxi, China
| | - Wenbin Liang
- Department of Radiology, Second Affiliated Hospital of Xi'an Jiao tong University, Xi'an, Shaanxi, China
| | - Xin Chen
- Department of Radiology, Second Affiliated Hospital of Xi'an Jiao tong University, Xi'an, Shaanxi, China.
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Coskun Bilge A, Aydin H. Assessment of the contribution of the ADC value to the Kaiser score in the differential diagnosis of breast lesions with non-mass enhancement morphology on MRI. Eur J Radiol 2024; 181:111713. [PMID: 39241300 DOI: 10.1016/j.ejrad.2024.111713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 08/28/2024] [Accepted: 08/30/2024] [Indexed: 09/09/2024]
Abstract
PURPOSE To investigate the effectiveness of diffusion-weighted imaging (DWI) as a supplementary tool to the Kaiser score (KS) in diagnosing breast cancer in non-mass enhancement (NME) lesions using breast magnetic resonance imaging (MRI). METHODS This single-center, retrospective study analyzed 360 cases with NME on MRI images. Two breast radiologists independently evaluated each lesion using the Kaiser score (KS) and apparent diffusion coefficient (ADC) values, without knowledge of the pathological outcomes. NME lesions with a KS above 4 and an ADC value below 1.3 × 10-3mm2/s were classified as malignant. Inter-rater reliability was determined using Cohen's Kappa (κ) statistics. The diagnostic performance of KS, DWI, and their combination was assessed by calculating sensitivity, specificity, and the area under the curve (AUC), and the results were compared across the benign and malignant groups. RESULTS The diagnostic performance of KS surpassed that of DWI in predicting the malignancy of NMEs (p = 0.003). The sensitivity of KS alone was 93 %; however, when ADC data was incorporated, the sensitivity decreased to 86 %, with no significant difference observed (p = 0.060). The specificity of the combined KS and ADC (94 %) was significantly higher than that of KS alone (89 %) and DWI alone (73 %) (p < 0.001). CONCLUSION Our findings indicated that although the combination of KS and ADC increased specificity and reduced unnecessary biopsies, the resulting decrease in sensitivity was unacceptable. Therefore, KS alone is superior to the KS-ADC combination in detecting malignancy in NME lesions.
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Affiliation(s)
- Almila Coskun Bilge
- Department of Radiology, Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey.
| | - Hale Aydin
- Department of Radiology, University of Health Sciences, Gulhane Faculty of Medicine, Ankara, Turkey.
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Hijazi M, Chahine R, Berjawi G, Jabbour Y, El Annan T, Ibrahim R, Nassar L. Reliability of Kaiser Score in Assessing Additional Breast Lesions Identified on Staging MRI in Patients with Breast Cancer. Diagnostics (Basel) 2024; 14:1726. [PMID: 39202214 PMCID: PMC11353333 DOI: 10.3390/diagnostics14161726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Revised: 07/28/2024] [Accepted: 08/01/2024] [Indexed: 09/03/2024] Open
Abstract
(1) Background: The Kaiser score is a user-friendly tool that evaluates lesions on breast MRI and has been studied in the general population and a few specific clinical scenarios. We aim to evaluate the performance of the Kaiser score in the characterization of additional lesions identified on staging breast MRI. (2) Methods: The Kaiser score of the biopsied additional lesions identified on staging MRI in recently diagnosed breast cancer patients was retrospectively determined. Statistical analysis was performed to evaluate the diagnostic capability of the Kaiser score and whether it is affected by different imaging and pathological parameters of the additional and the index lesion. (3) Results: Seventy-six patients with ninety-two MRI-detected lesions constitute the studied population. There was a statistically significant difference in the Kaiser score between benign and malignant lesions, irrespective of the pathology of the index cancer (p = 0.221) or the size and the imaging features of the additional lesion. Using a cutoff of 5 and above for suspicious lesions, biopsy could have been avoided in 34/92 lesions. (4) Conclusions: The Kaiser score can assist radiologists in the evaluation of additional MRI lesions identified in recently diagnosed breast cancer patients, thus decreasing the number of unneeded biopsies and delays in definitive surgical management.
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Affiliation(s)
- Madiha Hijazi
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut 1107, Lebanon; (M.H.); (R.C.); (G.B.); (Y.J.); (T.E.A.)
| | - Reve Chahine
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut 1107, Lebanon; (M.H.); (R.C.); (G.B.); (Y.J.); (T.E.A.)
| | - Ghina Berjawi
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut 1107, Lebanon; (M.H.); (R.C.); (G.B.); (Y.J.); (T.E.A.)
| | - Yara Jabbour
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut 1107, Lebanon; (M.H.); (R.C.); (G.B.); (Y.J.); (T.E.A.)
| | - Tamara El Annan
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut 1107, Lebanon; (M.H.); (R.C.); (G.B.); (Y.J.); (T.E.A.)
| | - Roy Ibrahim
- Department of Diagnostic Radiology, Lebanese American University Medical Center, Beirut 1100, Lebanon;
| | - Lara Nassar
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut 1107, Lebanon; (M.H.); (R.C.); (G.B.); (Y.J.); (T.E.A.)
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Rong X, Kang Y, Li Y, Xue J, Li Z, Yang G. Application of the Kaiser score on contrast-enhanced mammography in the differential diagnosis of breast lesions: comparison with breast magnetic resonance imaging. Quant Imaging Med Surg 2024; 14:5541-5554. [PMID: 39144044 PMCID: PMC11320531 DOI: 10.21037/qims-24-593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 06/20/2024] [Indexed: 08/16/2024]
Abstract
Background The Kaiser score (KS) as a clinical decision rule has been proven capable of enhancing the diagnostic efficiency for suspicious breast lesions and obviating unnecessary benign biopsies. However, the consistency of KS in contrast-enhanced mammography (CEM-KS) and KS on magnetic resonance imaging (MRI-KS) is still unclear. This study aimed to evaluate and compare the diagnostic efficacy and agreement of CEM-KS and MRI-KS for suspicious breast lesions. Methods This retrospective study included 207 patients from April 2019 to June 2022. The radiologists assigned a diagnostic category to all lesions using the Breast Imaging Reporting and Data System (BI-RADS). Subsequently, they were asked to assign a final diagnostic category for each lesion according to the KS. The diagnostic performance was evaluated by the area under the receiver operating characteristic curve (AUC). The agreement in terms of the kinetic curve and the KS categories for CEM and MRI were evaluated via the Cohen kappa coefficient. Results The AUC was higher for the CEM-KS category assignment than for the CEM-BI-RADS category assignment (0.856 vs. 0.776; P=0.047). The AUC was higher for MRI-KS than for MRI-BI-RADS (0.841 vs. 0.752; P =0.015). The AUC of CEM-KS was not significantly different from that of MRI-KS (0.856 vs. 0.841; P=0.538). The difference between the AUCs for CEM-BI-RADS and MRI-BI-RADS was not statistically significant (0.776 vs. 0.752; P=0.400). The kappa agreement for the characterization of suspicious breast lesions using CEM-KS and MRI-KS was 0.885. Conclusions The KS substantially improved the diagnostic performance of suspicious breast lesions, not only in MRI but also in CEM. CEM-KS and MRI-KS showed similar diagnostic performance and almost perfect agreement for the characterization of suspicious breast lesions. Therefore, CEM holds promise as an alternative when breast MRI is not available or contraindicated.
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Affiliation(s)
- Xiaocui Rong
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yihe Kang
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yanan Li
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jing Xue
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhigang Li
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Guang Yang
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
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Zhou J, Liu H, Miao H, Ye S, He Y, Zhao Y, Chen Z, Zhang Y, Liu YL, Pan Z, Su MY, Wang M. Breast lesions on MRI in mass and non-mass enhancement: Kaiser score and modified Kaiser score + for readers of variable experience. Eur Radiol 2024:10.1007/s00330-024-10922-1. [PMID: 38990324 DOI: 10.1007/s00330-024-10922-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 03/23/2024] [Accepted: 05/28/2024] [Indexed: 07/12/2024]
Abstract
OBJECTIVES To compare the diagnostic performance of three readers using BI-RADS and Kaiser score (KS) based on mass and non-mass enhancement (NME) lesions. METHODS A total of 630 lesions, 393 malignant and 237 benign, 458 mass and 172 NME, were analyzed. Three radiologists with 3 years, 6 years, and 13 years of experience made diagnoses. 596 cases had diffusion-weighted imaging, and the apparent diffusion coefficient (ADC) was measured. For lesions with ADC > 1.4 × 10-3 mm2/s, the KS was reduced by 4 as the modified KS +, and the benefit was assessed. RESULTS When using BI-RADS, AUC was 0.878, 0.915, and 0.941 for mass, and 0.771, 0.838, 0.902 for NME for Reader-1, 2, and 3, respectively, better for mass than for NME. The diagnostic accuracy of KS was improved compared to BI-RADS for less experienced readers. For Reader-1, AUC was increased from 0.878 to 0.916 for mass (p = 0.005) and from 0.771 to 0.822 for NME (p = 0.124). Based on the cut-off value of BI-RADS ≥ 4B and KS ≥ 5 as malignant, the sensitivity of KS by Readers-1 and -2 was significantly higher for both Mass and NME. When ADC was considered to change to modified KS +, the AUC and the accuracy for all three readers were improved, showing higher specificity with slightly degraded sensitivity. CONCLUSION The benefit of KS compared to BI-RADS was most noticeable for the less experienced readers in improving sensitivity. Compared to KS, KS + can improve specificity for all three readers. For NME, the KS and KS + criteria need to be further improved. CLINICAL RELEVANCE STATEMENT KS provides an intuitive method for diagnosing lesions on breast MRI. BI-RADS and KS face greater difficulties in evaluating NME compared to mass lesions. Adding ADC to the KS can improve specificity with slightly degraded sensitivity. KEY POINTS KS provides an intuitive method for interpreting breast lesions on MRI, most helpful for novice readers. KS, compared to BI-RADS, improved sensitivity in both mass and NME groups for less experienced readers. NME lesions were considered during the development of the KS flowchart, but may need to be better defined.
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Affiliation(s)
- Jiejie Zhou
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Department of Radiological Sciences, University of California, Irvine, CA, US
| | - Huiru Liu
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Haiwei Miao
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shuxin Ye
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yun He
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Youfan Zhao
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhongwei Chen
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yang Zhang
- Department of Radiological Sciences, University of California, Irvine, CA, US
| | - Yan-Lin Liu
- Department of Radiological Sciences, University of California, Irvine, CA, US
| | - Zhifang Pan
- First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Min-Ying Su
- Department of Radiological Sciences, University of California, Irvine, CA, US.
- Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Meihao Wang
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
- Key Laboratory of Intelligent Medical Imaging of Wenzhou, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
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Li S, Lin Y, Liu G, Shao Z, Yang Y. Unveiling the potential of breast MRI: a game changer for BI-RADS 4A microcalcifications. Breast Cancer Res Treat 2024; 206:425-435. [PMID: 38664289 DOI: 10.1007/s10549-024-07320-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 03/28/2024] [Indexed: 06/19/2024]
Abstract
PURPOSE To assess the diagnostic performance of breast MRI for BI-RADS 4A microcalcifications on mammography and propose a potential clinical pathway to avoid unnecessary biopsies. METHODS Bibliometrics analysis of breast MRI and BI-RADS 4 was provided. A retrospective analysis was conducted on 139 women and 142 cases of BI-RADS 4A microcalcifications on mammography from Fudan University Shanghai Cancer Center. The mammographic BI-RADS level and the MRI reports were compared with the final pathological diagnosis. RESULTS Much attention has been given to breast MRI and BI-RADS 4 in the literature. However, studies on BI-RADS 4A are limited. Pathological results showed 117 cases (82.4%) were benign lesions, malignant cases of 25 (17.6%) in our study. The positive predictive values (PPV), specificity, sensitivity and negative predictive values (NPV) of MRI were 44.2% (23/52), 75.2% (88/117), 92.0% (23/25), and 97.8% (88/90), respectively. Therefore, 75.2% (88/117) of biopsies for benign lesions could potentially be avoided. There were 2.2% (2/90) malignant lesions missed. Logistic regression indicated that patients who are postmenopausal (HR = 2.655, p = 0.012), have a history of breast cancer (family history) (HR = 2.833, p = 0.029), and exhibit clustered microcalcifications (HR = 2.179, p = 0.046) are more likely to have a higher MRI BI-RADS level. CONCLUSIONS Breast MRI has the potential to improve the diagnosis of BI-RADS 4A microcalcifications on mammography. We propose a potential clinical pathway that patients with BI-RADS 4A on mammography who are premenopausal, have no personal history of breast cancer (family history) or have non-clustered distribution of calcifications can undergo MRI to avoid unnecessary biopsies.
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Affiliation(s)
- Shiping Li
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Fudan University, Shanghai Medical College, Shanghai, China
| | - Yihao Lin
- The First School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Guangyu Liu
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Fudan University, Shanghai Medical College, Shanghai, China
| | - Zhimin Shao
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Fudan University, Shanghai Medical College, Shanghai, China
| | - Yinlong Yang
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.
- Department of Oncology, Fudan University, Shanghai Medical College, Shanghai, China.
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Pötsch N, Clauser P, Kapetas P, Baykara Ulusan M, Helbich T, Baltzer P. Enhancing the Kaiser score for lesion characterization in unenhanced breast MRI. Eur J Radiol 2024; 176:111520. [PMID: 38820953 DOI: 10.1016/j.ejrad.2024.111520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/15/2024] [Accepted: 05/19/2024] [Indexed: 06/02/2024]
Abstract
PURPOSE To adapt the methodology of the Kaiser score, a clinical decision rule for lesion characterization in breast MRI, for unenhanced protocols. METHOD In this retrospective IRB-approved cross-sectional study, we included 93 consecutive patients who underwent breast MRI between 2021 and 2023 for further work-up of BI-RADS 0, 3-5 in conventional imaging or for staging purposes (BI-RADS 6). All patients underwent biopsy for histologic verification or were followed for a minimum of 12 months. MRI scans were conducted using 1.5 T or 3 T scanners using dedicated breast coils and a protocol in line with international recommendations including DWI and ADC. Lesion characterization relied solely on T2w and DWI/ADC-derived features (such as lesion type, margins, shape, internal signal, surrounding tissue findings, ADC value). Statistical analysis was done using decision tree analysis aiming to distinguish benign (histology/follow-up) from malignant outcomes. RESULTS We analyzed a total of 161 lesions (81 of them non-mass) with a malignancy rate of 40%. Lesion margins (spiculated, irregular, or circumscribed) were identified as the most important criterion within the decision tree, followed by the ADC value as second most important criterion. The resulting score demonstrated a strong diagnostic performance with an AUC of 0.840, providing both rule-in and rule-out criteria. In an independent test set of 65 lesions the diagnostic performance was verified by two readers (AUC 0.77 and 0.87, kappa: 0.62). CONCLUSIONS We developed a clinical decision rule for unenhanced breast MRI including lesion margins and ADC value as the most important criteria, achieving high diagnostic accuracy.
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Affiliation(s)
- N Pötsch
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna and General Hospital, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - P Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna and General Hospital, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - P Kapetas
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna and General Hospital, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - M Baykara Ulusan
- Department of Radiology, University of Health Sciences Istanbul Training and Research Hospital, Org. Abdurrahman Nafiz Gurman Cad, No:1 Fatih, İstanbul, Turkey
| | - T Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna and General Hospital, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - P Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna and General Hospital, Waehringer Guertel 18-20, 1090 Vienna, Austria.
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Pötsch N, Vatteroni G, Clauser P, Rainer E, Kapetas P, Milos R, Helbich TH, Baltzer P. Using the Kaiser Score as a clinical decision rule for breast lesion classification: Does computer-assisted curve type analysis improve diagnosis? Eur J Radiol 2024; 170:111271. [PMID: 38185026 DOI: 10.1016/j.ejrad.2023.111271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 01/09/2024]
Abstract
PURPOSE We aimed to investigate the effect of using visual or automatic enhancement curve type assessment on the diagnostic performance of the Kaiser Score (KS), a clinical decision rule for breast MRI. METHOD This IRB-approved retrospective study analyzed consecutive conventional BI-RADS 0, 4 or 5 patients who underwent biopsy after 1.5T breast MRI according to EUSOBI recommendations between 2013 and 2015. The KS includes five criteria (spiculations; signal intensity (SI)-time curve type; margins of the lesion; internal enhancement; and presence of edema) resulting in scores from 1 (=lowest) to 11 (=highest risk of breast cancer). Enhancement curve types (Persistent, Plateau or Wash-out) were assessed by two radiologists independently visually and using a pixel-wise color-coded computed parametric map of curve types. KS diagnostic performance differences between readings were compared by ROC analysis. RESULTS In total 220 lesions (147 benign, 73 malignant) including mass (n = 148) and non-mass lesions (n = 72) were analyzed. KS reading performance in distinguishing benign from malignant lesions did not differ between visual analysis and parametric map (P = 0.119; visual: AUC 0.875, sensitivity 95 %, specificity 63 %; and map: AUC 0.901, sensitivity 97 %, specificity 65 %). Additionally, analyzing mass and non-mass lesions separately, showed no difference between parametric map based and visual curve type-based KS analysis as well (P = 0.130 and P = 0.787). CONCLUSIONS The performance of the Kaiser Score is largely independent of the curve type assessment methodology, confirming its robustness as a clinical decision rule for breast MRI in any type of breast lesion in clinical routine.
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Affiliation(s)
- N Pötsch
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - G Vatteroni
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - P Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - E Rainer
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - P Kapetas
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - R Milos
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - T H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Structural Preclinical Imaging, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - P Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
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Dietzel M, Bernathova M, Clauser P, Kapetas P, Uder M, Baltzer PAT. Added value of clinical decision rules for the management of enhancing breast MRI lesions: A systematic comparison of the Kaiser score and the Göttingen score. Eur J Radiol 2023; 169:111185. [PMID: 37939606 DOI: 10.1016/j.ejrad.2023.111185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/16/2023] [Accepted: 11/02/2023] [Indexed: 11/10/2023]
Abstract
PURPOSE We investigated the added value of two internationally used clinical decision rules in the management of enhancing lesions on breast MRI. METHODS This retrospective, institutional review board approved study included consecutive patients from two different populations. Patients received breast MRI according to the recommendations of the European Society of Breast Imaging (EUSOBI). Initially, all examinations were assessed by expert readers without using clinical decision rules. All lesions rated as category 4 or 5 according to the Breast Imaging Reporting and Data System were histologically confirmed. These lesions were re-evaluated by an expert reader blinded to the histology. He assigned each lesion a Göttingen score (GS) and a Kaiser score (KS) on different occasions. To provide an estimate on inter-reader agreement, a second fellowship-trained reader assessed a subset of these lesions. Subgroup analyses based on lesion type (mass vs. non-mass), size (>1 cm vs. ≤ 1 cm), menopausal status, and significant background parenchymal enhancement were conducted. The areas under the ROC curves (AUCs) for the GS and KS were compared, and the potential to avoid unnecessary biopsies was determined according to previously established cutoffs (KS > 4, GS > 3) RESULTS: 527 lesions in 506 patients were included (mean age: 51.8 years, inter-quartile-range: 43.0-61.0 years). 131/527 lesions were malignant (24.9 %; 95 %-confidence-interval: 21.3-28.8). In all subgroups, the AUCs of the KS (median = 0.91) were higher than those of the GS (median = 0.83). Except for "premenopausal patients" (p = 0.057), these differences were statistically significant (p ≤ 0.01). Kappa agreement was higher for the KS (0.922) than for the GS (0.358). CONCLUSION Both the KS and the GS provided added value for the management of enhancing lesions on breast MRI. The KS was superior to the GS in terms of avoiding unnecessary biopsies and showed superior inter-reader agreement; therefore, it may be regarded as the clinical decision rule of choice.
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Affiliation(s)
- Matthias Dietzel
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 3, 91054 Erlangen, Germany.
| | - Maria Bernathova
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer-Guertel 18-20, Vienna, Austria.
| | - Paola Clauser
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer-Guertel 18-20, Vienna, Austria.
| | - Panagiotis Kapetas
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer-Guertel 18-20, Vienna, Austria.
| | - Michael Uder
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 3, 91054 Erlangen, Germany.
| | - Pascal A T Baltzer
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer-Guertel 18-20, Vienna, Austria.
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Wang H, Gao L, Chen X, Wang SJ. Quantitative evaluation of Kaiser score in diagnosing breast dynamic contrast-enhanced magnetic resonance imaging for patients with high-grade background parenchymal enhancement. Quant Imaging Med Surg 2023; 13:6384-6394. [PMID: 37869283 PMCID: PMC10585520 DOI: 10.21037/qims-23-113] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 07/28/2023] [Indexed: 10/24/2023]
Abstract
Background High-grade background parenchymal enhancement (BPE), including moderate and marked, poses a considerable challenge for the diagnosis of breast disease due to its tendency to increase the rate of false positives and false negatives. The purpose of our study was to explore whether the Kaiser score can be used for more accurate assessment of benign and malignant lesions in high-grade BPE compared with the Breast Imaging Reporting and Data System (BI-RADS). Methods A retrospective review was conducted on consecutive breast dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) scans from 2 medical centers. Included were patients who underwent DCE-MRI demonstrating high-grade BPE and who had a pathology-confirmed diagnosis. Excluded were patients who had received neoadjuvant chemotherapy or who had undergone biopsy prior to MRI examination. Two physicians with more than 7 years of experience specializing in breast imaging diagnosis jointly reviewed breast magnetic resonance (MR) images. The Kaiser score was used to determine the sensitivity, specificity, and positive predictive value (PPV), and negative predictive value (NPV) of the BI-RADS from different BPE groups and different enhancement types. The performance of the Kaiser score and BI-RADS were compared according to diagnostic accuracy. Results A total of 126 cases of high-grade BPE from 2 medical centers were included in this study. The Kaiser score had a higher specificity and PPV than did the BI-RADS (87.5% vs. 46.3%) as well as a higher PPV (94.3% vs. 79.8%). The value of diagnostic accuracy and 95% confidence interval (CI) for the Kaiser score (accuracy 0.928; 95% CI: 0.883-0.973) was larger than that for BI-RADS (accuracy 0.810; 95% CI: 0.741-0.879). Moreover, the Kaiser score had a significantly higher value of diagnostic accuracy for both mass and non-mass enhancement, especially mass lesions (Kaiser score: accuracy 0.947, 95% CI: 0.902-0.992; BI-RADS: accuracy 0.821, 95% CI: 0.782-0.860), with a P value of 0.006. Conclusions The Kaiser score is a useful diagnostic tool for the evaluation of high-grade BPE lesions, with a higher specificity, PPV, and diagnostic accuracy as compared to the BI-RADS.
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Affiliation(s)
- Hui Wang
- Department of Radiology, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, China
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ling Gao
- Department of Radiology, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, China
| | - Xu Chen
- Department of Thyroid and Breast Surgery, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, China
| | - Shou-Ju Wang
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Brown AL, Vijapura C, Patel M, De La Cruz A, Wahab R. Breast Cancer in Dense Breasts: Detection Challenges and Supplemental Screening Opportunities. Radiographics 2023; 43:e230024. [PMID: 37792590 DOI: 10.1148/rg.230024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Dense breast tissue at mammography is associated with higher breast cancer incidence and mortality rates, which have prompted new considerations for breast cancer screening in women with dense breasts. The authors review the definition and classification of breast density, density assessment methods, breast cancer risk, current legislation, and future efforts and summarize trials and key studies that have affected the existing guidelines for supplemental screening. Cases of breast cancer in dense breasts are presented, highlighting a variety of modalities and specific imaging findings that can aid in cancer detection and staging. Understanding the current state of breast cancer screening in patients with dense breasts and its challenges is important to shape future considerations for care. Shifting the paradigm of breast cancer detection toward early diagnosis for women with dense breasts may be the answer to reducing the number of deaths from this common disease. ©RSNA, 2023 Online supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center. See the invited commentary by Yeh in this issue.
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Affiliation(s)
- Ann L Brown
- From the Department of Radiology, University of Cincinnati Medical Center, 3188 Bellevue Ave, Cincinnati, OH 45219-0772 (A.L.B., C.V., A.D.L.C., R.W.); and Department of Radiology, Ohio State University Medical Center, Columbus, Ohio (M.P.)
| | - Charmi Vijapura
- From the Department of Radiology, University of Cincinnati Medical Center, 3188 Bellevue Ave, Cincinnati, OH 45219-0772 (A.L.B., C.V., A.D.L.C., R.W.); and Department of Radiology, Ohio State University Medical Center, Columbus, Ohio (M.P.)
| | - Mitva Patel
- From the Department of Radiology, University of Cincinnati Medical Center, 3188 Bellevue Ave, Cincinnati, OH 45219-0772 (A.L.B., C.V., A.D.L.C., R.W.); and Department of Radiology, Ohio State University Medical Center, Columbus, Ohio (M.P.)
| | - Alexis De La Cruz
- From the Department of Radiology, University of Cincinnati Medical Center, 3188 Bellevue Ave, Cincinnati, OH 45219-0772 (A.L.B., C.V., A.D.L.C., R.W.); and Department of Radiology, Ohio State University Medical Center, Columbus, Ohio (M.P.)
| | - Rifat Wahab
- From the Department of Radiology, University of Cincinnati Medical Center, 3188 Bellevue Ave, Cincinnati, OH 45219-0772 (A.L.B., C.V., A.D.L.C., R.W.); and Department of Radiology, Ohio State University Medical Center, Columbus, Ohio (M.P.)
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Meng L, Zhao X, Guo J, Lu L, Cheng M, Xing Q, Shang H, Zhang B, Chen Y, Zhang P, Zhang X. Improved Differential Diagnosis Based on BI-RADS Descriptors and Apparent Diffusion Coefficient for Breast Lesions: A Multiparametric MRI Analysis as Compared to Kaiser Score. Acad Radiol 2023; 30 Suppl 2:S93-S103. [PMID: 37236897 DOI: 10.1016/j.acra.2023.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/23/2023] [Accepted: 03/23/2023] [Indexed: 05/28/2023]
Abstract
RATIONALE AND OBJECTIVES To develop the nomogram utilizing the American College of Radiology BI-RADS descriptors, clinical features, and apparent diffusion coefficient (ADC) to differentiate benign from malignant breast lesions. MATERIALS AND METHODS A total of 341 lesions (161 malignant and 180 benign) were included. Clinical data and imaging features were reviewed. Univariable and multivariable logistic regression analyses were performed to determine the independent variables. ADC as a continuous or classified into binary form with a cutoff value of 1.30 × 10-3 mm2/s, incorporated other independent predictors to construct two nomograms, respectively. Receiver operating curve and calibration plot was employed to test the models' discriminative ability. The diagnostic performance between the developed model and the Kaiser score (KS) was also compared. RESULTS In both models, high patient age, the presence of root sign, time-intensity curves (TICs) types (plateau and washout), heterogenous internal enhancement, the presence of peritumoral edema, and ADC were independently associated with malignancy. The AUCs of two multivariable models (AUC, 0.957; 95% CI: 0.929-0.976 and AUC, 0.958; 95% CI: 0.931-0.976) were significantly higher than that of the KS (AUC, 0.919, 95% CI: 0.885-0.946; both P < 0.001). At the same sensitivity of 95.7%, our models showed an increase in specificity by 5.56% (P = 0.076) and 6.11% (P = 0.035), respectively, as compared to the KS. CONCLUSION The models incorporating MRI features (root sign, TIC, margins, internal enhancement, and presence of edema), quantitative ADC value, and patient age showed improved diagnostic performance and might have avoided more unnecessary biopsies in comparison with the KS, although further external validation is required.
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Affiliation(s)
- Lingsong Meng
- Department of Radiology, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China (L.M., X.Z., L.L., M.C., Q.X., H.S., Y.C., P.Z., X.Z.); Academy of Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China (L.M., P.Z.).
| | - Xin Zhao
- Department of Radiology, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China (L.M., X.Z., L.L., M.C., Q.X., H.S., Y.C., P.Z., X.Z.).
| | - Jinxia Guo
- General Electric (GE) Healthcare, Beijing, China (J.G.).
| | - Lin Lu
- Department of Radiology, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China (L.M., X.Z., L.L., M.C., Q.X., H.S., Y.C., P.Z., X.Z.).
| | - Meiying Cheng
- Department of Radiology, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China (L.M., X.Z., L.L., M.C., Q.X., H.S., Y.C., P.Z., X.Z.).
| | - Qingna Xing
- Department of Radiology, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China (L.M., X.Z., L.L., M.C., Q.X., H.S., Y.C., P.Z., X.Z.).
| | - Honglei Shang
- Department of Radiology, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China (L.M., X.Z., L.L., M.C., Q.X., H.S., Y.C., P.Z., X.Z.).
| | - Bohao Zhang
- Henan Key Laboratory of Child Brain Injury, Institute of Neuroscience and the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China (B.Z.).
| | - Yan Chen
- Department of Radiology, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China (L.M., X.Z., L.L., M.C., Q.X., H.S., Y.C., P.Z., X.Z.).
| | - Penghua Zhang
- Department of Radiology, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China (L.M., X.Z., L.L., M.C., Q.X., H.S., Y.C., P.Z., X.Z.); Academy of Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China (L.M., P.Z.).
| | - Xiaoan Zhang
- Department of Radiology, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China (L.M., X.Z., L.L., M.C., Q.X., H.S., Y.C., P.Z., X.Z.).
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Pan J, Huang X, Yang S, Ouyang F, Ouyang L, Wang L, Chen M, Zhou L, Du Y, Chen X, Deng L, Hu Q, Guo B. The added value of apparent diffusion coefficient and microcalcifications to the Kaiser score in the evaluation of BI-RADS 4 lesions. Eur J Radiol 2023; 165:110920. [PMID: 37320881 DOI: 10.1016/j.ejrad.2023.110920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/22/2023] [Accepted: 06/04/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE To explore the added value of combining microcalcifications or apparent diffusion coefficient (ADC) with the Kaiser score (KS) for diagnosing BI-RADS 4 lesions. METHODS This retrospective study included 194 consecutive patients with 201 histologically verified BI-RADS 4 lesions. Two radiologists assigned the KS value to each lesion. Adding microcalcifications, ADC, or both these criteria to the KS yielded KS1, KS2, and KS3, respectively. The potential of all four scores to avoid unnecessary biopsies was assessed using the sensitivity and specificity. Diagnostic performance was evaluated by the area under the curve (AUC) and compared between KS and KS1. RESULTS The sensitivity of KS, KS1, KS2, and KS3 ranged from 77.1% to 100.0%.KS1 yielded significantly higher sensitivity than other methods (P < 0.05), except for KS3 (P > 0.05), most of all, when assessing NME lesions. For mass lesions, the sensitivity of these four scores was comparable (p > 0.05). The specificity of KS, KS1, KS2, and KS3 ranged from 56.0% to 69.4%, with no statistically significant differences(P > 0.05), except between KS1 and KS2 (p < 0.05).The AUC of KS1 (0.877) was significantly higher than that of KS (0.837; P = 0.0005), particularly for assessing NME (0.847 vs 0.713; P < 0.0001). CONCLUSION KS can stratify BI-RADS 4 lesions to avoid unnecessary biopsies. Adding microcalcifications, but not adding ADC, as an adjunct to KS improves diagnostic performance, particularly for NME lesions. ADC provides no additional diagnostic benefit to KS. Thus, only combining microcalcifications with KS is most conducive to clinical practice.
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Affiliation(s)
- Jialing Pan
- Department of Radiology, Shunde Hospital, Southern Medical University(The First People's Hospital of Shunde, Foshan), Foshan, Guangdong, China
| | - Xiyi Huang
- Department of Clinical Laboratory, Lecong Hospital of Shunde, Foshan, Guangdong, China
| | - Shaomin Yang
- Department of Radiology, Lecong Hospital of Shunde, Foshan, Guangdong, China
| | - Fusheng Ouyang
- Department of Radiology, Shunde Hospital, Southern Medical University(The First People's Hospital of Shunde, Foshan), Foshan, Guangdong, China
| | - Lizhu Ouyang
- Department of Ultrasound, Shunde Hospital, Southern Medical University(The First People's Hospital of Shunde, Foshan), Foshan, Guangdong, China
| | - Liwen Wang
- Department of Radiology, Shunde Hospital, Southern Medical University(The First People's Hospital of Shunde, Foshan), Foshan, Guangdong, China
| | - Ming Chen
- Department of Radiology, Shunde Hospital, Southern Medical University(The First People's Hospital of Shunde, Foshan), Foshan, Guangdong, China
| | - Lanni Zhou
- Department of Radiology, Shunde Hospital, Southern Medical University(The First People's Hospital of Shunde, Foshan), Foshan, Guangdong, China
| | - Yongxing Du
- Department of Radiology, Shunde Hospital, Southern Medical University(The First People's Hospital of Shunde, Foshan), Foshan, Guangdong, China
| | - Xinjie Chen
- Department of Radiology, Shunde Hospital, Southern Medical University(The First People's Hospital of Shunde, Foshan), Foshan, Guangdong, China
| | - Lingda Deng
- Department of Radiology, Shunde Hospital, Southern Medical University(The First People's Hospital of Shunde, Foshan), Foshan, Guangdong, China
| | - Qiugen Hu
- Department of Radiology, Shunde Hospital, Southern Medical University(The First People's Hospital of Shunde, Foshan), Foshan, Guangdong, China.
| | - Baoliang Guo
- Department of Radiology, Shunde Hospital, Southern Medical University(The First People's Hospital of Shunde, Foshan), Foshan, Guangdong, China.
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Zhou XZ, Liu LH, He S, Yao HF, Chen LP, Deng C, Li SL, Zhang XY, Lai H. Diagnostic value of Kaiser score combined with breast vascular assessment from breast MRI for the characterization of breast lesions. Front Oncol 2023; 13:1165405. [PMID: 37483510 PMCID: PMC10359820 DOI: 10.3389/fonc.2023.1165405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 06/06/2023] [Indexed: 07/25/2023] Open
Abstract
Objectives The Kaiser scoring system for breast magnetic resonance imaging is a clinical decision-making tool for diagnosing breast lesions. However, the Kaiser score (KS) did not include the evaluation of breast vascularity. Therefore, this study aimed to use KS combined with breast vascular assessment, defined as KS*, and investigate the effectiveness of KS* in differentiating benign from malignant breast lesions. Methods This retrospective study included 223 patients with suspicious breast lesions and pathologically verified results. The histopathological diagnostic criteria were according to the fifth edition of the WHO classification of breast tumors. The KS* was obtained after a joint evaluation combining the original KS and breast vasculature assessment. The receiver operating characteristic (ROC) curve was used for comparing differences in the diagnostic performance between KS* and KS, and the area under the receiver operating characteristic (AUC) was compared. Results There were 119 (53.4%) benign and 104 (46.6%) malignant lesions in total. The overall sensitivity, specificity, and accuracy of increased ipsilateral breast vascularity were 69.2%, 76.5%, and 73.1%, respectively. The overall sensitivity, specificity, and accuracy of AVS were 82.7%, 76.5%, and 79.4%, respectively. For all lesions included the AUC of KS* was greater than that of KS (0.877 vs. 0.858, P = 0.016). The largest difference in AUC was observed in the non-mass subgroup (0.793 vs. 0.725, P = 0.029). Conclusion Ipsilaterally increased breast vascularity and a positive AVS sign were significantly associated with malignancy. KS combined with breast vascular assessment can effectively improve the diagnostic ability of KS for breast lesions, especially for non-mass lesions.
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Affiliation(s)
- Xin-zhu Zhou
- Department of Radiology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Lian-hua Liu
- Department of Radiology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Shuang He
- Department of Radiology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Hui-fang Yao
- Department of Radiology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Li-ping Chen
- Department of Radiology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Chen Deng
- Department of Radiology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Shuang-Ling Li
- Department of Radiology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | | | - Hua Lai
- Department of Radiology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Avdan Aslan A, Gültekin S. Diagnostic performance of Kaiser score in patients with newly diagnosed breast cancer: Factors associated with false-negative results. Eur J Radiol 2023; 164:110864. [PMID: 37209464 DOI: 10.1016/j.ejrad.2023.110864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 04/28/2023] [Accepted: 05/02/2023] [Indexed: 05/22/2023]
Abstract
PURPOSE To investigate the factors associated with false-negative results in the diagnosis of breast cancer via breast magnetic resonance imaging (MRI) using the Kaiser score (KS). METHODS This institutional review board (IRB)-approved, single-center, retrospective study enrolled 219 consecutive histopathologically proven breast cancer lesions in 205 women who underwent preoperative breast MRI. Two breast radiologists evaluated each lesion according to the KS. The clinicopathological characteristics and imaging findings were also analyzed. Interobserver variability was assessed using the intraclass correlation coefficient (ICC). Multivariate regression analysis was used to investigate factors associated with false-negative KS results for breast cancer diagnosis. RESULTS Of 219 breast cancers, KS yielded 200 (91.3%) true-positive and 19 (8.7%) false-negative results. The interobserver ICC for the KS between the two readers was good, with a value of 0.804 (95% CI 0.751-0.846). Multivariate regression analysis revealed that small lesion size (≤1 cm) (adjusted OR 6.86, 95% CI 2.14-21.94, p = 0.001) and personal breast cancer history (adjusted OR 7.59, 95% CI, 1.55-37.23, p = 0.012) were significantly associated with false-negative KS results. CONCLUSION Small lesion size (≤1 cm) and presence of personal breast cancer history are factors significantly associated with false-negative KS results. Our results suggest that radiologists should consider these factors in clinical practice as potential pitfalls of KS, which may be compensated for by a multimodal approach combined with clinical evaluation.
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Affiliation(s)
- Aydan Avdan Aslan
- Department of Radiology, Faculty of Medicine, Gazi University, Ankara, Turkey.
| | - Serap Gültekin
- Department of Radiology, Faculty of Medicine, Gazi University, Ankara, Turkey
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Lyu Y, Chen Y, Meng L, Guo J, Zhan X, Chen Z, Yan W, Zhang Y, Zhao X, Zhang Y. Combination of ultrafast dynamic contrast-enhanced MRI-based radiomics and artificial neural network in assessing BI-RADS 4 breast lesions: Potential to avoid unnecessary biopsies. Front Oncol 2023; 13:1074060. [PMID: 36816972 PMCID: PMC9929366 DOI: 10.3389/fonc.2023.1074060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/16/2023] [Indexed: 02/04/2023] Open
Abstract
Objectives To investigate whether combining radiomics extracted from ultrafast dynamic contrast-enhanced MRI (DCE-MRI) with an artificial neural network enables differentiation of MR BI-RADS 4 breast lesions and thereby avoids false-positive biopsies. Methods This retrospective study consecutively included patients with MR BI-RADS 4 lesions. The ultrafast imaging was performed using Differential sub-sampling with cartesian ordering (DISCO) technique and the tenth and fifteenth postcontrast DISCO images (DISCO-10 and DISCO-15) were selected for further analysis. An experienced radiologist used freely available software (FAE) to perform radiomics extraction. After principal component analysis (PCA), a multilayer perceptron artificial neural network (ANN) to distinguish between malignant and benign lesions was developed and tested using a random allocation approach. ROC analysis was performed to evaluate the diagnostic performance. Results 173 patients (mean age 43.1 years, range 18-69 years) with 182 lesions (95 benign, 87 malignant) were included. Three types of independent principal components were obtained from the radiomics based on DISCO-10, DISCO-15, and their combination, respectively. In the testing dataset, ANN models showed excellent diagnostic performance with AUC values of 0.915-0.956. Applying the high-sensitivity cutoffs identified in the training dataset demonstrated the potential to reduce the number of unnecessary biopsies by 63.33%-83.33% at the price of one false-negative diagnosis within the testing dataset. Conclusions The ultrafast DCE-MRI radiomics-based machine learning model could classify MR BI-RADS category 4 lesions into benign or malignant, highlighting its potential for future application as a new tool for clinical diagnosis.
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Affiliation(s)
- Yidong Lyu
- Department I of Breast, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yan Chen
- Department of Radiology, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Lingsong Meng
- Department of Radiology, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Jinxia Guo
- General Electric (GE) Healthcare, MR Research China, Beijing, China
| | - Xiangyu Zhan
- Department I of Breast, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhuo Chen
- Department I of Breast, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wenjun Yan
- Department I of Breast, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuyan Zhang
- Department I of Breast, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xin Zhao
- Department of Radiology, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China,*Correspondence: Xin Zhao, ; Yanwu Zhang,
| | - Yanwu Zhang
- Department I of Breast, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China,*Correspondence: Xin Zhao, ; Yanwu Zhang,
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Jones LI, Klimczak K, Geach R. Breast MRI: an illustration of benign findings. Br J Radiol 2023; 96:20220280. [PMID: 36488196 PMCID: PMC9975519 DOI: 10.1259/bjr.20220280] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 08/24/2022] [Accepted: 09/29/2022] [Indexed: 12/13/2022] Open
Abstract
Despite its unparalleled sensitivity for aggressive breast cancer, breast MRI continually excites criticism for a specificity that lags behind that of modern mammographic techniques. Radiologists reporting breast MRI need to recognise the range of benign appearances on breast MRI to avoid unnecessary biopsy. This review summarises the reported diagnostic accuracy of breast MRI with particular attention to the technique's specificity, provides a referenced reporting strategy and discusses factors that compromise diagnostic confidence. We then present a pictorial review of benign findings on breast MRI. Enhancing radiological skills to discriminate malignant from benign findings will minimise false positive biopsies, enabling optimal use of multiparametric breast MRI for the benefit of screening clients and breast cancer patients.
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Affiliation(s)
- Lyn Isobel Jones
- Bristol Breast Care Centre, North Bristol NHS Trust, Bristol, United Kingdom
| | - Katherine Klimczak
- Bristol Breast Care Centre, North Bristol NHS Trust, Bristol, United Kingdom
| | - Rebecca Geach
- Bristol Breast Care Centre, North Bristol NHS Trust, Bristol, United Kingdom
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Kang Y, Li Z, Yang G, Xue J, Zhang L, Rong X. Diagnostic performance of the Kaiser score in the evaluation of breast lesions on contrast-enhanced mammography. Eur J Radiol 2022; 156:110524. [PMID: 36126352 DOI: 10.1016/j.ejrad.2022.110524] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/14/2022] [Accepted: 09/09/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES We aimed to investigate whether the Kaiser score (KS) could improve the diagnostic performance of breast imaging reporting and data system (BI-RADS) in evaluating breast enhancing lesions on contrast-enhanced mammography (CEM). METHODS Three hundred fifty-nine patients with 375 lesions (231 malignant and 144 benign) were included in this retrospective study from April 2019 to December 2021.Two readers with different levels of experience in breast imaging were asked to give a BI-RADS assessment category according to the CEM BI-RADS and final score based on the KS. The diagnostic performance of all lesions, mass and non-mass enhancement (NME) were assessed by receiver operating characteristic (ROC) analysis, and the areas under the ROC curve (AUCs) were measured. The weighted kappa coefficients were calculated to investigate the interreader agreement. RESULTS The AUCs of the KS for all lesions were 0.915 (95 %CI: 0.884-0.947) and 0.876 (95 %CI: 0.838-0.914) for two readers. When mass and NME were evaluated separately, the AUCs of the KS for mass were higher than those for NME (p < 0.001). The AUCs of BI-RADS for all lesion diagnoses ranged between 0.821 (95 %CI: 0.778-0.864) and 0.842(95 %CI: 0.801-0.883) for two readers. The AUCs of the KS were higher than those of BI-RADS (p < 0.001, p = 0.016). There were no significant differences in the sensitivity between the KS (97.4 %) and BI-RADS (99.6 %) for all lesions (p = 0.130). The specificity of the KS was significantly higher than that of BI-RADS (p < 0.001). Compared with BI-RADS, the application of the KS could have potentially obviated 41.7 % to 47.9 % unnecessary biopsies in 144 benign lesions. Interreader agreement between the two readers of the KS was almost perfect (k = 0.883 [95 % CI: 0.842-0.924]). CONCLUSION The use of the KS provided a high diagnostic performance in distinguishing malignant and benign breast lesions on CEM and outperformed BI-RADS. The application of the KS can downgrade up to 47.9% of unnecessary biopsies of benign breast lesions.
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Affiliation(s)
- Yihe Kang
- Department of Radiology. The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China
| | - Zhigang Li
- Department of Radiology. The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China
| | - Guang Yang
- Department of Radiology. The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China
| | - Jing Xue
- Department of Radiology. The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China
| | - Lingling Zhang
- Department of Pathology. The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China
| | - Xiaocui Rong
- Department of Radiology. The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China.
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Rong X, Kang Y, Xue J, Han P, Li Z, Yang G, Shi G. Value of contrast-enhanced mammography combined with the Kaiser score for clinical decision-making regarding tomosynthesis BI-RADS 4A lesions. Eur Radiol 2022; 32:7439-7447. [PMID: 35639141 DOI: 10.1007/s00330-022-08810-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/22/2022] [Accepted: 04/14/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To investigate the diagnostic performance of contrast-enhanced mammography (CEM) combined with the Kaiser score (KS) in digital breast tomosynthesis (DBT) BI-RADS 4A lesions to potentially reduce unnecessary breast biopsies. METHODS This retrospective study evaluated 106 patients with 109 DBT BI-RADS 4A lesions from June 2019 to June 2021. For the absence of enhancement on CEM, the lesions were downgraded to BI-RADS 3. For lesions with enhancement, the readers were asked to classify all enhancing lesions referring to the KS for breast MRI. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic performance. Two readers rated all cases and interreader agreement was assessed by Cohen's kappa coefficients. RESULTS There were ninety-five benign lesions and 14 malignant lesions. CEM combined with KS's accuracy, represented by the area under the curve (AUC), ranged between 0.880 and 0.906. The use of the KS improved the performance, with a significant difference relative to a single BI-RADS reading or US (p < 0.001). CEM with KS had higher specificity than CEM with BI-RADS or US (p < 0.001), without difference in sensitivity (p > 0.05). CEM combined with KS could have potentially obviated 72 (75.8%) to 78 (82.1%) unnecessary benign biopsies in 95 benign lesions previously DBT classified as BI-RADS 4A. The interreader agreement was substantial (kappa: 0.727) for KS. CONCLUSIONS CEM combined with KS may be used in DBT BI-RADS 4A lesions to substantially reduce unnecessary benign biopsies. KEY POINTS • CEM combined with the Kaiser scoring system shows high diagnostic performance for DBT BI-RADS 4A lesions. • The application of CEM combined with the Kaiser scoring system may avoid 75.8% to 82.1% of unnecessary benign breast biopsies. • CEM combined with the KS aids clinical decision-making in DBT BI-RADS 4A lesions.
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Affiliation(s)
- Xiaocui Rong
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China
| | - Yihe Kang
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China
| | - Jing Xue
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China
| | - Pengyin Han
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China
| | - Zhigang Li
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China
| | - Guang Yang
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China
| | - Gaofeng Shi
- Department of Computed Tomography and Magnetic Resonance, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China.
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Meng L, Zhao X, Guo J, Lu L, Cheng M, Xing Q, Shang H, Wang K, Zhang B, Lei D, Zhang X. Evaluation of the differentiation of benign and malignant breast lesions using synthetic relaxometry and the Kaiser score. Front Oncol 2022; 12:964078. [PMID: 36303839 PMCID: PMC9595598 DOI: 10.3389/fonc.2022.964078] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/26/2022] [Indexed: 12/24/2022] Open
Abstract
Objective To investigate whether there is added value of quantitative parameters from synthetic magnetic resonance imaging (SyMRI) as a complement to the Kaiser score (KS) to differentiate benign and malignant breast lesions. Materials and methods In this single-institution study, 122 patients who underwent breast MRI from March 2020 to May 2021 were retrospectively analyzed. SyMRI and dynamic contrast-enhanced MRI were performed using a 3.0-T system. Two experienced radiologists independently assigned the KS and measured the quantitative values of T1 relaxation time (T1), T2 relaxation time (T2), and proton density (PD) from SyMRI. Pathology was regarded as the gold standard. The diagnostic values were compared using the appropriate statistical tests. Results There were 122 lesions (86 malignant and 36 benign) in 122 women. The T1 value was identified as the only independent factor for the differentiation of malignant and benign lesions. The diagnostic accuracy of incorporating the T1 into the KS protocol (T1+KS) was 95.1% and 92.1% for all lesions (ALL) and The American College of Radiology (ACR) Breast Imaging Reporting and Data System (BI-RADS) category 4 lesions, respectively, which was significantly higher than that of either T1 (ALL: 82.8%, P = 0.0001; BI-RADS 4: 78.9%, P = 0.002) or KS (ALL: 90.2%, P = 0.031; BI-RADS 4: 84.2%, P = 0.031) alone. The sensitivity and specificity of T1+KS were also higher than those of the T1 or KS alone. The combined diagnosis could have avoided another 15.6% biopsies compared with using KS alone. Conclusions Incorporating T1 into the KS protocol improved both the sensitivity and specificity to differentiate benign and malignant breast lesions, thus avoiding unnecessary invasive procedures.
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Affiliation(s)
- Lingsong Meng
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Academy of Medical Sciences, Zhengzhou University, Zhengzhou, China
| | - Xin Zhao
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jinxia Guo
- General Electric (GE) Healthcare, MR Research China, Beijing, China
| | - Lin Lu
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Meiying Cheng
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qingna Xing
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Honglei Shang
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Kaiyu Wang
- General Electric (GE) Healthcare, MR Research China, Beijing, China
| | - Bohao Zhang
- Henan Key Laboratory of Child Brain Injury, Institute of Neuroscience and the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dongmei Lei
- Department of Pathology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaoan Zhang
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Xiaoan Zhang,
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Systematic analysis of changes in radiomics features during dynamic breast-MRI: Evaluation of specific biomarkers. Clin Imaging 2022; 93:93-102. [DOI: 10.1016/j.clinimag.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/17/2022] [Indexed: 11/19/2022]
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22
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Can DWI provide additional value to Kaiser score in evaluation of breast lesions. Eur Radiol 2022; 32:5964-5973. [PMID: 35357535 DOI: 10.1007/s00330-022-08674-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 05/28/2021] [Accepted: 06/07/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To explore added value of diffusion-weighted imaging (DWI) as an adjunct to Kaiser score (KS) for differentiation of benign from malignant lesions on breast magnetic resonance imaging (MRI). METHODS Two hundred forty-six patients with 273 lesions (155 malignancies) were included in this retrospective study from January 2015 to December 2019. All lesions were proved by pathology. Two radiologists blind to pathological results evaluated lesions according to KS. Lesions with score > 4 were considered malignant. Four thresholds of ADC values -1.3 × 10-3mm2/s, 1.4 × 10-3mm2/s, 1.53 × 10-3mm2/s, and 1.6 × 10-3mm2/s were used to distinguish benign from malignant lesions. For combined diagnosis, a lesion with KS > 4 and ADC values below the preset cutoffs was considered as malignant; otherwise, it was benign. Sensitivity, specificity, and area under the curve (AUC) were compared between KS, DWI, and combined diagnosis. RESULTS The AUC of KS was significantly higher than that of DWI alone (0.941 vs 0.901, p = 0.04). The sensitivity of KS (96.8%) and DWI (97.4 - 99.4%) was comparable (p > 0.05) while the specificity of KS (83.9%) was significantly higher than that of DWI (19.5-56.8%) (p < 0.05). Adding DWI as an adjunct to KS resulted in a 0-2.5% increase of specificity and a 0.1-1.3% decrease of sensitivity; however, the difference did not reach statistical significance (p > 0.05). CONCLUSION KS showed higher diagnostic performance than DWI alone for discrimination of breast benign and malignant lesions. DWI showed no additional value to KS for characterizing breast lesions. KEY POINTS • KS showed higher diagnostic performance than DWI alone for differentiation of benign from breast malignant lesions. • DWI alone showed a high sensitivity but a low specificity for characterizing breast lesions. • Diagnostic performance did not improve using DWI as an adjunct to KS.
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Zhong Y, Li M, Zhu J, Zhang B, Liu M, Wang Z, Wang J, Zheng Y, Cheng L, Li X. A simplified scoring protocol to improve diagnostic accuracy with the breast imaging reporting and data system in breast magnetic resonance imaging. Quant Imaging Med Surg 2022; 12:3860-3872. [PMID: 35782247 PMCID: PMC9246725 DOI: 10.21037/qims-21-1036] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 04/19/2022] [Indexed: 12/31/2023]
Abstract
BACKGROUND The breast imaging reporting and data system (BI-RADS) lexicon provides a standardized terminology for describing leision characteristics but does not provide defined rules for converting specific imaging features into diagnostic categories. The inter-reader agreement of the BI-RADS is moderate. In this study, we explored the use of a simplified protocol and scoring system for BI-RADS categorization which integrates the morphologic features (MF), kinetic time-intensity curve (TIC), and apparent diffusion coefficient (ADC) values with equal weights, with a view to providing a convenient and practical method for breast magnetic resonance imaging (MRI) and improving the inter-reader agreement and diagnostic performance of BI-RADS. METHODS This cross-sectional, retrospective, single-center study included 879 patients with 898 histopathologically verified lesions who underwent an MRI scan on a 3.0 Tesla GE Discovery 750 MRI scanner between January 1, 2017, and June 30, 2020. The BI-RADS categorization of the studied lesions was assessed according to the sum of the assigned scores (the presence of malignant MF, lower ADC, and suspicious TIC each warranted a score of +1). Total scores of +2 and +3 were classified as category 5, scores of +1 were classified as category 4, and scores of +0 but with other lesions of interest were classified as category 3. The receiver operating characteristic (ROC) curves were plotted, and the sensitivity, specificity, and accuracy of this categorization were investigated to assess its efficacy and its consistency with pathology. RESULTS There were 472 malignant, 104 risk, and 322 benign lesions. Our simplified scoring protocol had high diagnostic accuracy, with an area under curve (AUC) value of 0.896. In terms of the borderline effect of pathological risk and category 4 lesions, our results showed that when risk lesions were classified together with malignant ones, the AUC value improved (0.876 vs. 0.844 and 0.909 vs. 0.900). When category 4 and 5 lesions were classified as malignant, the specificity, accuracy, and AUC value decreased (82.3% vs. 93.2%, 89.3% vs. 90.2%, and 0.876 vs. 0.909, respectively). Therefore, to improve the diagnostic accuracy of the protocol for BI-RADS categorization, only category 5 lesions should be considered to be malignant. CONCLUSIONS Our simplified scoring protocol that integrates MF, TIC, and ADC values with equal weights for BI-RADS categorization could improve both the diagnostic performance of the protocol for BI-RADS categorization in clinical practice and the understanding of the benign-risk-malignant breast diseases.
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Affiliation(s)
- Yuting Zhong
- Medical School of Chinese People’s Liberation Army, Beijing, China
- Department of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Menglu Li
- Department of Radiology, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Jingjin Zhu
- Department of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing, China
- School of Medicine, Nankai University, Tianjin, China
| | - Boya Zhang
- Department of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing, China
- School of Medicine, Nankai University, Tianjin, China
| | - Mei Liu
- Department of Pathology, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Zhili Wang
- Department of Ultrasound, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Jiandong Wang
- Department of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Yiqiong Zheng
- Department of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Liuquan Cheng
- Department of Radiology, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Xiru Li
- Department of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing, China
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Belhaj Soulami K, Kaabouch N, Nabil Saidi M. Breast cancer: Classification of suspicious regions in digital mammograms based on capsule network. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2022.103696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Baltzer PAT, Krug KB, Dietzel M. Evidence-Based and Structured Diagnosis in Breast MRI using the Kaiser Score. ROFO-FORTSCHR RONTG 2022; 194:1216-1228. [PMID: 35613905 DOI: 10.1055/a-1829-5985] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Breast MRI is the most sensitive method for the detection of breast cancer and is an integral part of modern breast imaging. On the other hand, interpretation of breast MRI exams is considered challenging due to the complexity of the available information. Clinical decision rules that combine diagnostic criteria in an algorithm can help the radiologist to read breast MRI by supporting objective and largely experience-independent diagnosis. METHOD Narrative review. In this article, the Kaiser Score (KS) as a clinical decision rule for breast MRI is introduced, its diagnostic criteria are defined, and strategies for clinical decision making using the KS are explained and discussed. RESULTS The KS is based on machine learning and has been independently validated by international research. It is largely independent of the examination technique that is used. It allows objective differentiation between benign and malignant contrast-enhancing breast MRI findings using diagnostic BI-RADS criteria taken from T2w and dynamic contrast-enhanced T1w images. A flowchart guides the reader in up to three steps to determine a score corresponding to the probability of malignancy that can be used to assign a BI-RADS category. Individual decision making takes the clinical context into account and is illustrated by typical scenarios. KEY POINTS · The KS as an evidence-based decision rule to objectively distinguish benign from malignant breast lesions is based on information contained in T2w und dynamic contrast-enhanced T1w sequences and is largely independent of specific examination protocols.. · The KS diagnostic criteria are in line with the MRI BI-RADS lexicon. We focused on defining a default category to be applied in the case of equivocal imaging criteria.. · The KS reflects increasing probabilities of malignancy and, together with the clinical context, assists individual decision making.. CITATION FORMAT · Baltzer PA, Krug KB, Dietzel M. Evidence-Based and Structured Diagnosis in Breast MRI using the Kaiser Score. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1829-5985.
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Affiliation(s)
- Pascal Andreas Thomas Baltzer
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Medical University of Vienna, Wien, Austria
| | - Kathrin Barbara Krug
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Köln, Germany
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Liu X, Xie L, Ye X, Cui Y, He N, Hu L. Evaluation of Ultrasound Elastography Combined With Chi-Square Automatic Interactive Detector in Reducing Unnecessary Fine-Needle Aspiration on TIRADS 4 Thyroid Nodules. Front Oncol 2022; 12:823411. [PMID: 35251988 PMCID: PMC8889496 DOI: 10.3389/fonc.2022.823411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 01/26/2022] [Indexed: 12/09/2022] Open
Abstract
Background Conventional ultrasound diagnosis of thyroid nodules (TNs) had a high false-positive rate, resulting in many unnecessary fine-needle aspirations (FNAs). Objective This study aimed to establish a simple algorithm to reduce unnecessary FNA on TIRADS 4 TNs using different quantitative parameters of ultrasonic elasticity and chi-square automatic interactive detector (CHAID) method. Methods From January 2020 to May 2021, 432 TNs were included in the study, which were confirmed by FNA or surgical pathology. Each TN was examined using conventional ultrasound, sound touch elastography, and Shell measurement function. The quantitative parameters E and Eshell were recorded, and the Eshell/E values were calculated for each TN. The diagnostic performance of the quantitative parameters was evaluated using the receiver operating characteristic curves. The CHAID was used to classify and analyze the quantitative parameters, and the prediction model was established. Results A total of 226 TNs were malignant and 206 were benign. Eshell and Eshell/E ratio were included in the classification algorithm, which showed a depth of two ramifications (Eshell/E ≤ 0.988 or 0.988–1.043 or >1.043; if Eshell/E ≤ 0.988, then Eshell ≤ 64.0 or 64.0–74.0 or >74.0; if Eshell/E = 0.988–1.043, then Eshell ≤ 66.0 or > 66.0; if Eshell/E >1.043, then Eshell ≤ 69.0 or >69.0). The unnecessary FNAs could have been avoided in 57.3% of the cases using this algorithm. Conclusion The prediction model using quantitative parameters had high diagnostic performance; it could quickly distinguish benign lesions and avoid subjective influence to some extent.
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Affiliation(s)
- Xiao Liu
- Department of Ultrasound, The First Affiliated Hospital of University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Li Xie
- Department of Ultrasound, The First Affiliated Hospital of University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Xianjun Ye
- Department of Ultrasound, The First Affiliated Hospital of University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Yayun Cui
- Department of Ultrasound, The First Affiliated Hospital of University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Nianan He
- Department of Ultrasound, The First Affiliated Hospital of University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Lei Hu
- Department of Ultrasound, The First Affiliated Hospital of University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
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Chen J, Su X, Xu T, Luo Q, Zhang L, Tang G. Stratification of axillary lymph node metastasis risk with breast magnetic resonance imaging in breast cancer. Future Oncol 2022; 18. [PMID: 35139642 DOI: 10.2217/fon-2021-1559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aims: To develop a model based on breast MRI to stratify axillary lymph node metastasis (ALNM) in breast cancer. Patients & methods: A total of 134 eligible patients were used to build a predicting model, which was validated with an independent group of 57 patients and evaluated for accuracy and sensitivity. Results: A model based on breast MRI was developed and yielded total accuracy of 82.5% and sensitivities of 94.3, 64.3 and 62.5% to predict patients with no, low and heavy ALNM burden, respectively, in the validation group. Conclusion: A noninvasive model based on breast MRI was developed to preoperatively stratify ALNM in breast cancer; its performance needs to be validated and improved in future research.
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Affiliation(s)
- Jieying Chen
- Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Xiaolian Su
- Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Tingting Xu
- Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Qifeng Luo
- Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Lin Zhang
- Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Guangyu Tang
- Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
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Son D, Phillips J, Mehta TS, Mehta R, Brook A, Dialani VM. Patient preferences regarding use of contrast-enhanced imaging for breast cancer screening. Acad Radiol 2022; 29 Suppl 1:S229-S238. [PMID: 33846061 DOI: 10.1016/j.acra.2021.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/17/2021] [Accepted: 03/04/2021] [Indexed: 11/26/2022]
Abstract
RATIONALE AND OBJECTIVES Our purpose is to understand patient preferences towards contrast-enhanced imaging such as CEM or MRI for breast cancer screening. METHODS AND MATERIALS An anonymous survey was offered to all patients having screening mammography at a single academic institution from December 27 th 2019 to March 6 th 2020. Survey questions related to: (1) patients' background experiences (2) patients' concern for aspects of MRI and CEM measured using a 5-point Likert scale, and (3) financial considerations. RESULTS 75% (1011/1349) patients completed the survey. 53.0% reported dense breasts and of those, 47.6% had additional screening. 49.6% had experienced a callback, 29.0% had a benign biopsy, and 13.7% had prior CEM/MRI. 34.7% were satisfied with mammography for screening. A majority were neutral or not concerned with radiation exposure, contrast allergy, IV line placement, claustrophobia, and false positive exams. 54.7% were willing to pay at least $250-500 for screening MRI. Those reporting dense breasts were less satisfied with mammography for screening (p<0.001) and willing to pay more for MRI (p<0.001). If patients had prior CEM/MRI, there was less concern for an allergic reaction (p<0.001), IV placement (p=0.025), and claustrophobia (p=0.006). There was less concern for false positives if they had a prior benign biopsy (p=0.029) or prior CEM/MRI (p=0.005) and less concern for IV placement if they had dense breasts (p=0.007) or a previous callback (p=0.013). CONCLUSION The screening population may accept CEM or MRI as a screening exam despite its risks and cost, especially patients with dense breasts and patients who have had prior CEM/MRI.
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Meng L, Zhao X, Lu L, Xing Q, Wang K, Guo Y, Shang H, Chen Y, Huang M, Sun Y, Zhang X. A Comparative Assessment of MR BI-RADS 4 Breast Lesions With Kaiser Score and Apparent Diffusion Coefficient Value. Front Oncol 2021; 11:779642. [PMID: 34926290 PMCID: PMC8675081 DOI: 10.3389/fonc.2021.779642] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 11/10/2021] [Indexed: 12/24/2022] Open
Abstract
Objectives To investigate the diagnostic performance of the Kaiser score and apparent diffusion coefficient (ADC) to differentiate Breast Imaging Reporting and Data System (BI-RADS) Category 4 lesions at dynamic contrast-enhanced (DCE) MRI. Methods This was a single-institution retrospective study of patients who underwent breast MRI from March 2020 to June 2021. All image data were acquired with a 3-T MRI system. Kaiser score of each lesion was assigned by an experienced breast radiologist. Kaiser score+ was determined by combining ADC and Kaiser score. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of Kaiser score+, Kaiser score, and ADC. The area under the curve (AUC) values were calculated and compared by using the Delong test. The differences in sensitivity and specificity between different indicators were determined by the McNemar test. Results The study involved 243 women (mean age, 43.1 years; age range, 18-67 years) with 268 MR BI-RADS 4 lesions. Overall diagnostic performance for Kaiser score (AUC, 0.902) was significantly higher than for ADC (AUC, 0.81; p = 0.004). There were no significant differences in AUCs between Kaiser score and Kaiser score+ (p = 0.134). The Kaiser score was superior to ADC in avoiding unnecessary biopsies (p < 0.001). Compared with the Kaiser score alone, the specificity of Kaiser score+ increased by 7.82%, however, at the price of a lower sensitivity. Conclusion For MR BI-RADS category 4 breast lesions, the Kaiser score was superior to ADC mapping regarding the potential to avoid unnecessary biopsies. However, the combination of both indicators did not significantly contribute to breast cancer diagnosis of this subgroup.
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Affiliation(s)
- Lingsong Meng
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xin Zhao
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lin Lu
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qingna Xing
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Kaiyu Wang
- Magnetic Resonance (MR) Research China, General Electric (GE) Healthcare, Beijing, China
| | - Yafei Guo
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Honglei Shang
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yan Chen
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mengyue Huang
- Department of Magnetic Resonance Imaging (MRI), The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yongbing Sun
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaoan Zhang
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Frankhouser DE, Dietze E, Mahabal A, Seewaldt VL. Vascularity and Dynamic Contrast-Enhanced Breast Magnetic Resonance Imaging. FRONTIERS IN RADIOLOGY 2021; 1:735567. [PMID: 37492179 PMCID: PMC10364989 DOI: 10.3389/fradi.2021.735567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 11/11/2021] [Indexed: 07/27/2023]
Abstract
Angiogenesis is a key step in the initiation and progression of an invasive breast cancer. High microvessel density by morphological characterization predicts metastasis and poor survival in women with invasive breast cancers. However, morphologic characterization is subject to variability and only can evaluate a limited portion of an invasive breast cancer. Consequently, breast Magnetic Resonance Imaging (MRI) is currently being evaluated to assess vascularity. Recently, through the new field of radiomics, dynamic contrast enhanced (DCE)-MRI is being used to evaluate vascular density, vascular morphology, and detection of aggressive breast cancer biology. While DCE-MRI is a highly sensitive tool, there are specific features that limit computational evaluation of blood vessels. These include (1) DCE-MRI evaluates gadolinium contrast and does not directly evaluate biology, (2) the resolution of DCE-MRI is insufficient for imaging small blood vessels, and (3) DCE-MRI images are very difficult to co-register. Here we review computational approaches for detection and analysis of blood vessels in DCE-MRI images and present some of the strategies we have developed for co-registry of DCE-MRI images and early detection of vascularization.
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Affiliation(s)
- David E. Frankhouser
- Department of Population Sciences, City of Hope National Medical Center, Duarte, CA, United States
| | - Eric Dietze
- Department of Population Sciences, City of Hope National Medical Center, Duarte, CA, United States
| | - Ashish Mahabal
- Department of Astronomy, Division of Physics, Mathematics, and Astronomy, California Institute of Technology (Caltech), Pasadena, CA, United States
| | - Victoria L. Seewaldt
- Department of Population Sciences, City of Hope National Medical Center, Duarte, CA, United States
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Hernández L, Díaz GM, Posada C, Llano-Sierra A. Magnetic resonance imaging in diagnosis of indeterminate breast (BIRADS 3 & 4A) in a general population. Insights Imaging 2021; 12:149. [PMID: 34674056 PMCID: PMC8531154 DOI: 10.1186/s13244-021-01098-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 09/07/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Currently, mammography and ultrasonography are the most used imaging techniques for breast cancer screening. However, these examinations report many indeterminate studies with a low probability of being malignant, i.e., BIRADS 3 and 4A. This prospective study aims to evaluate the value of breast magnetic resonance imaging (MRI) to clarify the BIRADS categorization of indeterminate mammography or ultrasonography studies. METHODS MRI studies acquired prospectively from 105 patients previously classified as BIRADS 3 or 4A were analyzed independently by four radiologists with different experience levels. Interobserver agreement was determined by the first-order agreement coefficient (AC1), and divergent results were re-analyzed for consensus. The possible correlation between the MRI and the mammography/ultrasound findings was evaluated, and each study was independently classified in one of the five BIRADS categories (BIRADS 1 to 5). In lesions categorized as BIRADS 4 or 5 at MRI, histopathological diagnosis was established by image-guided biopsy; while short-term follow-up was performed in lesions rated as BIRADS 3. RESULTS Breast MRI was useful in diagnosing three invasive ductal carcinomas, upgraded from BIRADS 4A to BIRADS 5. It also allowed excluding malignancy in 86 patients (81.9%), avoiding 22 unnecessary biopsies and 64 short-term follow-ups. The MRI showed good diagnostic performance with the area under roc curve, sensitivity, specificity, PPV, and NPV of 0.995, 100%, 83.5%, 10.5%, and 100%, respectively. CONCLUSIONS MRI showed to be useful as a problem-solving tool to clarify indeterminate findings in breast cancer screening and avoiding unnecessary short-follow-ups and percutaneous biopsies.
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Affiliation(s)
- Liliana Hernández
- Grupo de Investigación del Instituto de Alta Tecnología Médica (IATM), Ayudas Diagnósticas Sura, Medellín, Colombia
| | - Gloria M Díaz
- MIRP Lab-Parque i, Instituto Tecnológico Metropolitano, Medellín, Colombia.
| | - Catalina Posada
- Grupo de Investigación del Instituto de Alta Tecnología Médica (IATM), Ayudas Diagnósticas Sura, Medellín, Colombia.,Universidad CES, Medellín, Colombia
| | - Alejandro Llano-Sierra
- Grupo de Investigación del Instituto de Alta Tecnología Médica (IATM), Ayudas Diagnósticas Sura, Medellín, Colombia.,Universidad CES, Medellín, Colombia
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Dietzel M, Krug B, Clauser P, Burke C, Hellmich M, Maintz D, Uder M, Bickel H, Helbich T, Baltzer PAT. A Multicentric Comparison of Apparent Diffusion Coefficient Mapping and the Kaiser Score in the Assessment of Breast Lesions. Invest Radiol 2021; 56:274-282. [PMID: 33122603 DOI: 10.1097/rli.0000000000000739] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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 × 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; 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.
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Affiliation(s)
- Matthias Dietzel
- From the Department of Radiology, University Hospital Erlangen, Erlangen, Germany
| | - Barbara Krug
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne
| | - Paola Clauser
- Division of Molecular and Gender Imaging, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Christina Burke
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne
| | - Martin Hellmich
- Institute of Medical Statistics and Bioinformatics, University Cologne, Cologne, Germany
| | - David Maintz
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne
| | - Michael Uder
- From the Department of Radiology, University Hospital Erlangen, Erlangen, Germany
| | - Hubert Bickel
- Division of Molecular and Gender Imaging, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Thomas Helbich
- Division of Molecular and Gender Imaging, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Pascal A T Baltzer
- Division of Molecular and Gender Imaging, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
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An A.I. classifier derived from 4D radiomics of dynamic contrast-enhanced breast MRI data: potential to avoid unnecessary breast biopsies. Eur Radiol 2021; 31:5866-5876. [PMID: 33744990 PMCID: PMC8270804 DOI: 10.1007/s00330-021-07787-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/12/2021] [Indexed: 12/20/2022]
Abstract
Objectives Due to its high sensitivity, DCE MRI of the breast (bMRI) is increasingly used for both screening and assessment purposes. The high number of detected lesions poses a significant logistic challenge in clinical practice. The aim was to evaluate a temporally and spatially resolved (4D) radiomics approach to distinguish benign from malignant enhancing breast lesions and thereby avoid unnecessary biopsies. Methods This retrospective study included consecutive patients with MRI-suspicious findings (BI-RADS 4/5). Two blinded readers analyzed DCE images using a commercially available software, automatically extracting BI-RADS curve types and pharmacokinetic enhancement features. After principal component analysis (PCA), a neural network–derived A.I. classifier to discriminate benign from malignant lesions was constructed and tested using a random split simple approach. The rate of avoidable biopsies was evaluated at exploratory cutoffs (C1, 100%, and C2, ≥ 95% sensitivity). Results Four hundred seventy (295 malignant) lesions in 329 female patients (mean age 55.1 years, range 18–85 years) were examined. Eighty-six DCE features were extracted based on automated volumetric lesion analysis. Five independent component features were extracted using PCA. The A.I. classifier achieved a significant (p < .001) accuracy to distinguish benign from malignant lesion within the test sample (AUC: 83.5%; 95% CI: 76.8–89.0%). Applying identified cutoffs on testing data not included in training dataset showed the potential to lower the number of unnecessary biopsies of benign lesions by 14.5% (C1) and 36.2% (C2). Conclusion The investigated automated 4D radiomics approach resulted in an accurate A.I. classifier able to distinguish between benign and malignant lesions. Its application could have avoided unnecessary biopsies. Key Points • Principal component analysis of the extracted volumetric and temporally resolved (4D) DCE markers favored pharmacokinetic modeling derived features. • An A.I. classifier based on 86 extracted DCE features achieved a good to excellent diagnostic performance as measured by the area under the ROC curve with 80.6% (training dataset) and 83.5% (testing dataset). • Testing the resulting A.I. classifier showed the potential to lower the number of unnecessary biopsies of benign breast lesions by up to 36.2%, p < .001 at the cost of up to 4.5% (n = 4) false negative low-risk cancers. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-07787-z.
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Istomin A, Masarwah A, Vanninen R, Okuma H, Sudah M. Diagnostic performance of the Kaiser score for characterizing lesions on breast MRI with comparison to a multiparametric classification system. Eur J Radiol 2021; 138:109659. [PMID: 33752000 DOI: 10.1016/j.ejrad.2021.109659] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/05/2021] [Accepted: 03/15/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE To determine the diagnostic performance of the Kaiser score and to compare it with the BI-RADS-based multiparametric classification system (MCS). METHOD Two breast radiologists, blinded to the clinical and pathological information, separately evaluated a database of 499 consecutive patients with structural 3.0 T breast MRI and 697 histopathologically verified lesions. The Kaiser scores and corresponding MCS categories were recorded. The sensitivity and specificity of the Kaiser score and the MCS categories to differentiate benign from malignant lesions were calculated. The interobserver reproducibility and receiver operating characteristic (ROC) parameters were analysed. RESULTS The sensitivity and specificity of the MCS were 100 % and 12 %, respectively, and those of the Kaiser score were 98.5 % and 34.8 % for reader 1 and 98.7 % and 47.5 % for reader 2. The area under the ROC-curve was 85.9 and 87.6 for readers 1 and 2. The interobserver intraclass correlation coefficient was excellent at 0.882. Reader 1 upgraded six lesions from BI-RADS 3 to a Kaiser score of >4, and reader 2 upgraded seven lesions. When applying the Kaiser score to 158 benign lesions readers 1 and 2 would have reduced the biopsy rate by 22.8 % and 35.4 %, respectively. CONCLUSIONS The Kaiser score showed high diagnostic accuracy with excellent interobserver reproducibility. The MCS had perfect sensitivity but low specificity. Although the Kaiser score had slightly lower sensitivity, its specificity was 3-4 times greater than that of the MCS. Thus, the Kaiser score has the potential to considerably reduce the biopsy rate for true negative lesions.
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Affiliation(s)
- Aleksandr Istomin
- Kuopio University Hospital, Diagnostic Imaging Center, Department of Clinical Radiology, Kuopio, Finland
| | - Amro Masarwah
- Kuopio University Hospital, Diagnostic Imaging Center, Department of Clinical Radiology, Kuopio, Finland
| | - Ritva Vanninen
- Kuopio University Hospital, Diagnostic Imaging Center, Department of Clinical Radiology, Kuopio, Finland; University of Eastern Finland, Cancer Center of Eastern Finland, Kuopio, Finland; University of Eastern Finland, Institute of Clinical Medicine, School of Medicine, Kuopio, Finland
| | - Hidemi Okuma
- Kuopio University Hospital, Diagnostic Imaging Center, Department of Clinical Radiology, Kuopio, Finland
| | - Mazen Sudah
- Kuopio University Hospital, Diagnostic Imaging Center, Department of Clinical Radiology, Kuopio, Finland; University of Eastern Finland, Cancer Center of Eastern Finland, Kuopio, Finland.
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Grippo C, Jagmohan P, Helbich TH, Kapetas P, Clauser P, Baltzer PAT. Correct determination of the enhancement curve is critical to ensure accurate diagnosis using the Kaiser score as a clinical decision rule for breast MRI. Eur J Radiol 2021; 138:109630. [PMID: 33744507 DOI: 10.1016/j.ejrad.2021.109630] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 02/28/2021] [Accepted: 03/02/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES the Kaiser score is increasingly recognized as a valuable tool to improve breast MRI interpretation. Contrast enhancement kinetics are the second most important diagnostic criterion, thus defining the curve type plays a crucial role in Kaiser score assessment. We investigate whether the timepoint used to determine the initial enhancement (earlyor peak) for the signal-intensity time curve analysis affects the diagnostic performance of the Kaiser score. METHODS This IRB-approved, retrospective, single-center study included 70 consecutives histologically verified breast MRI cases. Two off-site breast radiologists independently read all examinations using the Kaiser score, assessing the initial enhancement using three approaches: -first (1 st), second (2nd) and peak (maximum) of either 1 st or 2nd post-contrast timepoints. The initial enhancement was then compared to the last timepoint (delayed enhancement) to determine the curve type. Visual assessment of curve types was used for this study. Diagnostic performance was evaluated by receiver operating characteristics (ROC) analysis. RESULTS Kaiser score reading results using the peak enhancement of either the first or second timepoint performed significantly better than the other approaches (P < 0.05, respectively) and specifically achieved higher sensitivity. Diagnostic accuracy (AUC area under the curve) ranged between 85.4 % and 91.6 %, without significant differences between the two readers (P < 0.5). CONCLUSIONS Diagnostic performance of the Kaiser score is significantly influenced by how the initial enhancement timepoint is determined. Peak enhancement should be used as initial timepoint to avoid pitfalls due to timing or physiological differences.
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Affiliation(s)
- Cristina Grippo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Istituto di Radiologia, Fondazione Policlinico Universitario A.Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Pooja Jagmohan
- Department of Diagnostic Imaging, National University Hospital and Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University and General Hospital of Vienna, Austria
| | - Panagiotis Kapetas
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University and General Hospital of Vienna, Austria
| | - Paola Clauser
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University and General Hospital of Vienna, Austria
| | - Pascal A T Baltzer
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University and General Hospital of Vienna, Austria.
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Baltzer PAT. Supplemental screening using breast MRI in women with mammographically dense breasts. Eur J Radiol 2020; 136:109513. [PMID: 33422397 DOI: 10.1016/j.ejrad.2020.109513] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 12/28/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Pascal A T Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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Jajodia A, Sindhwani G, Pasricha S, Prosch H, Puri S, Dewan A, Batra U, Doval DC, Mehta A, Chaturvedi AK. Application of the Kaiser score to increase diagnostic accuracy in equivocal lesions on diagnostic mammograms referred for MR mammography. Eur J Radiol 2020; 134:109413. [PMID: 33290973 DOI: 10.1016/j.ejrad.2020.109413] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 10/29/2020] [Accepted: 11/09/2020] [Indexed: 01/09/2023]
Abstract
INTRODUCTION We aimed to interpret MR mammography (MRM) using the Kaiser scores for equivocal or inconclusive lesions on mammography (MG). METHODS Retrospective IRB-approved evaluation of 3623 MG for which MRM was deployed as a problem-solving tool, after inclusion-exclusion criteria were met. Three readers with different levels of experience assigned a final score from 1 to 11 based on the previously established tree classification system. Area under the curve (AUC) derived from receiver operating characteristic (ROC) analysis was used to determine the overall diagnostic performance for all lesions and separately for mass and non-mass enhancement. Sensitivity, specificity, and likelihood ratio values were obtained at different cut-off values of >4, > 5, and > 8 to rule in and rule out malignancy. RESULT Histopathology of 183 mass and 133 non-mass enhancement (NME) lesions show benign etiology in 95 and malignant in 221. The AUC was 0.796 [0.851 for mass and 0.715 for NME]. Applying the Kaiser score upgraded 202 lesions with correct prediction in 77 %, and downgraded 28 lesions with correct prediction in 60.8 %. Using a score <5 instead of <4 to rule out malignancy improved our diagnostic ability to correctly identify 100 % benign lesions. Applying Kaiser score correctly downgraded 60.8 % (17/28) lesions; thus avoiding biopsies in these. Using a high cut-off value>8 to rule-in malignancy, we correctly identified 59.7 % of lesions with 80 % specificity and positive likelihood ratio of 3. CONCLUSION The Kaiser score has clinical translation benefits when used as a problem-solving tool for inconclusive MG findings.
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Affiliation(s)
- Ankush Jajodia
- Department of Radiology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India.
| | - Geetika Sindhwani
- Department of Radiology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
| | - Sunil Pasricha
- Department of Histopathology, Rajiv Gandhi Cancer Institute, Delhi, India
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-guided Therapy, University of Vienna, Vienna, Austria
| | - Sunil Puri
- Department of Radiology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
| | - Ajay Dewan
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute, Delhi, India
| | - Ullas Batra
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
| | - Dinesh Chandra Doval
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
| | - Anurag Mehta
- Department of Laboratory & Transfusion Services and Director Research, Rajiv Gandhi Cancer Institute, Delhi, India
| | - Arvind K Chaturvedi
- Department of Radiology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
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Istomin A, Masarwah A, Okuma H, Sutela A, Vanninen R, Sudah M. A multiparametric classification system for lesions detected by breast magnetic resonance imaging. Eur J Radiol 2020; 132:109322. [DOI: 10.1016/j.ejrad.2020.109322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/19/2020] [Accepted: 09/24/2020] [Indexed: 12/18/2022]
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Hao W, Gong J, Wang S, Zhu H, Zhao B, Peng W. Application of MRI Radiomics-Based Machine Learning Model to Improve Contralateral BI-RADS 4 Lesion Assessment. Front Oncol 2020; 10:531476. [PMID: 33194589 PMCID: PMC7660748 DOI: 10.3389/fonc.2020.531476] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 09/24/2020] [Indexed: 12/16/2022] Open
Abstract
Objective This study aimed to explore the potential of magnetic resonance imaging (MRI) radiomics-based machine learning to improve assessment and diagnosis of contralateral Breast Imaging Reporting and Data System (BI-RADS) category 4 lesions in women with primary breast cancer. Materials and Methods A total of 178 contralateral BI-RADS 4 lesions (97 malignant and 81 benign) collected from 178 breast cancer patients were involved in our retrospective dataset. T1 + C and T2 weighted images were used for radiomics analysis. These lesions were randomly assigned to the training (n = 124) dataset and an independent testing dataset (n = 54). A three-dimensional semi-automatic segmentation method was performed to segment lesions depicted on T2 and T1 + C images, 1,046 radiomic features were extracted from each segmented region, and a least absolute shrinkage and operator feature selection method reduced feature dimensionality. Three support vector machine (SVM) classifiers were trained to build classification models based on the T2, T1 + C, and fusion image features, respectively. The diagnostic performance of each model was evaluated and tested using the independent testing dataset. The area under the receiver operating characteristic curve (AUC) was used as a performance metric. Results The T1+C image feature-based model and T2 image feature-based model yielded AUCs of 0.71 ± 0.07 and 0.69 ± 0.07 respectively, and the difference between them was not significant (P > 0.05). After fusing T1 + C and T2 imaging features, the proposed model’s AUC significantly improved to 0.77 ± 0.06 (P < 0.001). The fusion model yielded an accuracy of 74.1%, which was higher than that of the T1 + C (66.7%) and T2 (59.3%) image feature-based models. Conclusion The MRI radiomics-based machine learning model is a feasible method to assess contralateral BI-RADS 4 lesions. T2 and T1 + C image features provide complementary information in discriminating benign and malignant contralateral BI-RADS 4 lesions.
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Affiliation(s)
- Wen Hao
- Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Shandong Medical Imaging Research Institute, Shandong University, Jinan, China
| | - Jing Gong
- Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Shengping Wang
- Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hui Zhu
- Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Bin Zhao
- Shandong Medical Imaging Research Institute, Shandong University, Jinan, China
| | - Weijun Peng
- Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Zhang B, Feng L, Wang L, Chen X, Li X, Yang Q. [Kaiser score for diagnosis of breast lesions presenting as non-mass enhancement on MRI]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2020; 40:562-566. [PMID: 32895136 DOI: 10.12122/j.issn.1673-4254.2020.04.18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the diagnostic efficacy of Kaiser score for breast lesions presenting as non-mass enhancement. METHODS We collected data from patients with breast lesions presenting as non-mass enhancement on preoperative DCE-MRI between January, 2014 and June, 2019. All the cases were confirmed by surgical pathology or puncture biopsy. With pathology results as the gold standard, we evaluated the diagnostic efficacy of Kaiser score and MRI BI-RADS classification and the consistency between the diagnostic results by the two methods and the pathological results. RESULTS A total of 90 lesions were detected in 88 patients, including 28 benign lesions (31.1%) and 62 malignant lesions (68.9%). For diagnosis of the lesions, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of Kaiser Score were 100%, 75%, 89.9%, 100% and 92%, as compared with 93.5%, 46.4%, 79.5%, 76.5% and 78.9% of MRI BI-RADS, respectively. The diagnostic specificity of Kaiser score was significantly higher than that of BI-RADS classification (P=0.021). CONCLUSIONS The Kaiser score system provides a diagnostic strategy for BI-RADS classification of breast lesions with non-mass enhancement and has a better diagnostic efficacy than BI-RADS classification alone. The use of Kaiser score can significantly improve the diagnostic specificity of such breast lesions for inexperienced radiologists.
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Affiliation(s)
- Bing Zhang
- Department of Radiology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China
| | - Linlin Feng
- Department of Radiology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China
| | - Lin Wang
- Department of Radiology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China
| | - Xin Chen
- Department of Radiology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China
| | - Xiaohui Li
- Department of Radiology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China
| | - Quanxin Yang
- Department of Radiology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China
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Milos RI, Pipan F, Kalovidouri A, Clauser P, Kapetas P, Bernathova M, Helbich TH, Baltzer PAT. The Kaiser score reliably excludes malignancy in benign contrast-enhancing lesions classified as BI-RADS 4 on breast MRI high-risk screening exams. Eur Radiol 2020; 30:6052-6061. [PMID: 32504098 PMCID: PMC7553895 DOI: 10.1007/s00330-020-06945-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 04/08/2020] [Accepted: 05/08/2020] [Indexed: 11/29/2022]
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.
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Affiliation(s)
- Ruxandra Iulia Milos
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer-Guertel 18-20, A-1090, Vienna, Austria
| | - Francesca Pipan
- Institute of Diagnostic Radiology, University of Udine, Udine, Italy
| | | | - Paola Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer-Guertel 18-20, A-1090, Vienna, Austria
| | - Panagiotis Kapetas
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer-Guertel 18-20, A-1090, Vienna, Austria
| | - Maria Bernathova
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer-Guertel 18-20, A-1090, Vienna, Austria
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer-Guertel 18-20, A-1090, Vienna, Austria
| | - Pascal A T Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer-Guertel 18-20, A-1090, Vienna, Austria.
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Kolta M, Clauser P, Kapetas P, Bernathova M, Pinker K, Helbich TH, Baltzer PAT. Can second-look ultrasound downgrade MRI-detected lesions? A retrospective study. Eur J Radiol 2020; 127:108976. [PMID: 32339982 DOI: 10.1016/j.ejrad.2020.108976] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 03/18/2020] [Accepted: 03/22/2020] [Indexed: 02/03/2023]
Abstract
PURPOSE To determine whether MRI-detected suspicious (BIRADS 4 & 5) breast lesions can be downgraded using second-look ultrasound (SLU) and thus reduce unnecessarily performed breast biopsies. MATERIALS METHODS A retrospective single-center review of consecutive patients, who underwent breast MRI studies during a 12-month time period was performed. 94 patients with 103 lesions undergoing SLU of incidentally detected MRI BI-RADS 4&5 lesions which were not identified on previous ultrasound were included in the study. The SLU detection rate and SLU features of the lesions were assessed. Histology (91/103) or two year follow up (n = 12) were defined as the reference standard for lesion diagnosis. RESULTS 57 (55.3 %) of the 103 lesions were identified on SLU. 17 of the identified lesions were malignant (29.8 %). Lesions detected on ultrasound presented on MRI as masses in 66.7 % (38/57) and non-mass in 33.3 % (19/57). Our findings showed that it is possible to distinguish between malignant and benign lesions with SLU. The results were significant (p < 0.05) for the following morphological features: shape, orientation, margins, architectural distortion, hyperechoic rim/ edema. All lesions classified as SLU BI-RADS 2 in our study were benign and thus, 30 % of all unnecessary biopsies could potentially have been avoided. Including SLU BI-RADS 3 lesions, this rate increased to 60 %, while yielding one (of 17, 5.8 %) false negative result. All three BI-RADS 5 lesions detected by SLU presented as malignant on ultrasound. CONCLUSION SLU can potentially downgrade incidental MRI BIRADS 4 lesions. This may reduce the number of unnecessarily performed biopsies by 30-60 %, thus simplifying patient management.
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Affiliation(s)
- Michael Kolta
- Department of Biomedical Imaging and Image-Guided Therapy, General and Pediatric Radiology, Allgemeines Krankenhaus, Medical University of Vienna, Austria
| | - Paola Clauser
- Department of Biomedical Imaging and Image-Guided Therapy, General and Pediatric Radiology, Allgemeines Krankenhaus, Medical University of Vienna, Austria
| | - Panagiotis Kapetas
- Department of Biomedical Imaging and Image-Guided Therapy, General and Pediatric Radiology, Allgemeines Krankenhaus, Medical University of Vienna, Austria
| | - Maria Bernathova
- Department of Biomedical Imaging and Image-Guided Therapy, General and Pediatric Radiology, Allgemeines Krankenhaus, Medical University of Vienna, Austria
| | - Katja Pinker
- Department of Biomedical Imaging and Image-Guided Therapy, General and Pediatric Radiology, Allgemeines Krankenhaus, Medical University of Vienna, Austria; Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-Guided Therapy, General and Pediatric Radiology, Allgemeines Krankenhaus, Medical University of Vienna, Austria
| | - Pascal A T Baltzer
- Department of Biomedical Imaging and Image-Guided Therapy, General and Pediatric Radiology, Allgemeines Krankenhaus, Medical University of Vienna, Austria.
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Wengert GJ, Pipan F, Almohanna J, Bickel H, Polanec S, Kapetas P, Clauser P, Pinker K, Helbich TH, Baltzer PAT. Impact of the Kaiser score on clinical decision-making in BI-RADS 4 mammographic calcifications examined with breast MRI. Eur Radiol 2020; 30:1451-1459. [PMID: 31797077 PMCID: PMC7033072 DOI: 10.1007/s00330-019-06444-w] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/05/2019] [Accepted: 09/09/2019] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To investigate whether the application of the Kaiser score for breast magnetic resonance imaging (MRI) might downgrade breast lesions that present as mammographic calcifications and avoid unnecessary breast biopsies METHODS: This IRB-approved, retrospective, cross-sectional, single-center study included 167 consecutive patients with suspicious mammographic calcifications and histopathologically verified results. These patients underwent a pre-interventional breast MRI exam for further diagnostic assessment before vacuum-assisted stereotactic-guided biopsy (95 malignant and 72 benign lesions). Two breast radiologists with different levels of experience independently read all examinations using the Kaiser score, a machine learning-derived clinical decision-making tool that provides probabilities of malignancy by a formalized combination of diagnostic criteria. Diagnostic performance was assessed by receiver operating characteristics (ROC) analysis and inter-reader agreement by the calculation of Cohen's kappa coefficients. RESULTS Application of the Kaiser score revealed a large area under the ROC curve (0.859-0.889). Rule-out criteria, with high sensitivity, were applied to mass and non-mass lesions alike. The rate of potentially avoidable breast biopsies ranged between 58.3 and 65.3%, with the lowest rate observed with the least experienced reader. CONCLUSIONS Applying the Kaiser score to breast MRI allows stratifying the risk of breast cancer in lesions that present as suspicious calcifications on mammography and may thus avoid unnecessary breast biopsies. KEY POINTS • The Kaiser score is a helpful clinical decision tool for distinguishing malignant from benign breast lesions that present as calcifications on mammography. • Application of the Kaiser score may obviate 58.3-65.3% of unnecessary stereotactic biopsies of suspicious calcifications. • High Kaiser scores predict breast cancer with high specificity, aiding clinical decision-making with regard to re-biopsy in case of negative results.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Biopsy, Needle
- Breast/diagnostic imaging
- Breast/pathology
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/pathology
- Calcinosis/diagnostic imaging
- Calcinosis/pathology
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Intraductal, Noninfiltrating/diagnostic imaging
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Lobular/diagnostic imaging
- Carcinoma, Lobular/pathology
- Clinical Decision-Making
- Cross-Sectional Studies
- Decision Support Systems, Clinical
- Female
- Humans
- Image-Guided Biopsy
- Machine Learning
- Magnetic Resonance Imaging
- Mammography
- Middle Aged
- Probability
- ROC Curve
- Radiologists
- Retrospective Studies
- Sensitivity and Specificity
- Young Adult
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Affiliation(s)
- G J Wengert
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - F Pipan
- Institute of Diagnostic Radiology, University of Udine, Udine, Italy
| | - J Almohanna
- Security Forces Hospital, Riyadh, Saudi Arabia
| | - H Bickel
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - S Polanec
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - P Kapetas
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - P Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - K Pinker
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - T H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - P A T Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria.
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Sodano C, Clauser P, Dietzel M, Kapetas P, Pinker K, Helbich TH, Gussew A, Baltzer PA. Clinical relevance of total choline (tCho) quantification in suspicious lesions on multiparametric breast MRI. Eur Radiol 2020; 30:3371-3382. [PMID: 32065286 PMCID: PMC7248046 DOI: 10.1007/s00330-020-06678-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 01/03/2020] [Accepted: 01/27/2020] [Indexed: 12/24/2022]
Abstract
Purpose To assess the additional value of quantitative tCho evaluation to diagnose malignancy and lymph node metastases in suspicious lesions on multiparametric breast MRI (mpMRI, BI-RADS 4, and BI-RADS 5). Methods One hundred twenty-one patients that demonstrated suspicious multiparametric breast MRI lesions using DCE, T2w, and diffusion-weighted (DW) images were prospectively enrolled in this IRB-approved study. All underwent single-voxel proton MR spectroscopy (1H-MRS, point-resolved spectroscopy sequence, TR 2000 ms, TE 272 ms) with and without water suppression. The total choline (tCho) amplitude was measured and normalized to millimoles/liter according to established methodology by two independent readers (R1, R2). ROC-analysis was employed to predict malignancy and lymph node status by tCho results. Results One hundred three patients with 74 malignant and 29 benign lesions had full 1H-MRS data. The area under the ROC curve (AUC) for prediction of malignancy was 0.816 (R1) and 0.809 (R2). A cutoff of 0.8 mmol/l tCho could diagnose malignancy with a sensitivity of > 95%. For prediction of lymph node metastases, tCho measurements achieved an AUC of 0.760 (R1) and 0.788 (R2). At tCho levels < 2.4 mmol/l, no metastatic lymph nodes were found. Conclusion Quantitative tCho evaluation from 1H-MRS allowed diagnose malignancy and lymph node status in breast lesions suspicious on multiparametric breast MRI. tCho therefore demonstrated the potential to downgrade suspicious mpMRI lesions and stratify the risk of lymph node metastases for improved patient management. Key Points • Quantitative tCho evaluation can distinguish benign from malignant breast lesions suspicious after multiparametric MRI assessment. • Quantitative tCho levels are associated with lymph node status in breast cancer. • Quantitative tCho levels are higher in hormonal receptor positive compared to hormonal receptor negative lesions. Electronic supplementary material The online version of this article (10.1007/s00330-020-06678-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Claudia Sodano
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender, Imaging, Medical University of Vienna, Waehringer-Guertel 18-20, A-1090, Vienna, Austria
| | - Paola Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender, Imaging, Medical University of Vienna, Waehringer-Guertel 18-20, A-1090, Vienna, Austria
| | - Matthias Dietzel
- Institute of Radiology, Universitätsklinikum Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany
| | - Panagiotis Kapetas
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender, Imaging, Medical University of Vienna, Waehringer-Guertel 18-20, A-1090, Vienna, Austria
| | - Katja Pinker
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender, Imaging, Medical University of Vienna, Waehringer-Guertel 18-20, A-1090, Vienna, Austria
| | - Alexander Gussew
- Universitätsklinik und Poliklinik für Radiologie, Ernst-Grube-Str. 40, D-06120, Halle (Saale), Germany
| | - Pascal Andreas Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender, Imaging, Medical University of Vienna, Waehringer-Guertel 18-20, A-1090, Vienna, Austria.
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Quantitative Apparent Diffusion Coefficient Derived From Diffusion-Weighted Imaging Has the Potential to Avoid Unnecessary MRI-Guided Biopsies of mpMRI-Detected PI-RADS 4 and 5 Lesions. Invest Radiol 2018; 53:736-741. [DOI: 10.1097/rli.0000000000000498] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Schoub PK. Breast cancer imaging in South Africa in 2018. SA J Radiol 2018; 22:1666. [PMID: 31754521 PMCID: PMC6837797 DOI: 10.4102/sajr.v22i2.1666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Peter K Schoub
- Department of Radiology, Parklane Radiology, Johannesburg, South Africa
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A Simple Ultrasound Based Classification Algorithm Allows Differentiation of Benign from Malignant Breast Lesions by Using Only Quantitative Parameters. Mol Imaging Biol 2018; 20:1053-1060. [PMID: 29633108 PMCID: PMC6244531 DOI: 10.1007/s11307-018-1187-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Purpose We hypothesized that different quantitative ultrasound (US) parameters may be used as complementary diagnostic criteria and aimed to develop a simple classification algorithm to distinguish benign from malignant breast lesions and aid in the decision to perform biopsy or not. Procedures One hundred twenty-four patients, each with one biopsy-proven, sonographically evident breast lesion, were included in this prospective, IRB-approved study. Each lesion was examined with B-mode US, Color/Power Doppler US and elastography (Acoustic Radiation Force Impulse–ARFI). Different quantitative parameters were recorded for each technique, including pulsatility (PI) and resistive Index (RI) for Doppler US and lesion maximum, intermediate, and minimum shear wave velocity (SWVmax, SWVinterm, and SWVmin) as well as lesion-to-fat SWV ratio for ARFI. Receiver operating characteristic curve (ROC) analysis was used to evaluate the diagnostic performance of each quantitative parameter. Classification analysis was performed using the exhaustive chi-squared automatic interaction detection method. Results include the probability for malignancy for every descriptor combination in the classification algorithm. Results Sixty-five lesions were malignant and 59 benign. Out of all quantitative indices, maximum SWV (SWVmax), and RI were included in the classification algorithm, which showed a depth of three ramifications (SWVmax ≤ or > 3.16; if SWVmax ≤ 3.16 then RI ≤ 0.66, 0.66–0.77 or > 0.77; if RI ≤ 0.66 then SWVmax ≤ or > 2.71). The classification algorithm leads to an AUC of 0.887 (95 % CI 0.818–0.937, p < 0.0001), a sensitivity of 98.46 % (95 % CI 91.7–100 %), and a specificity of 61.02 % (95 % CI 47.4–73.5 %). By applying the proposed algorithm, a false-positive biopsy could have been avoided in 61 % of the cases. Conclusions A simple classification algorithm incorporating two quantitative US parameters (SWVmax and RI) shows a high diagnostic performance, being able to accurately differentiate benign from malignant breast lesions and lower the number of unnecessary breast biopsies in up to 60 % of all cases, avoiding any subjective interpretation bias.
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Dietzel M, Baltzer PAT. How to use the Kaiser score as a clinical decision rule for diagnosis in multiparametric breast MRI: a pictorial essay. Insights Imaging 2018; 9:325-335. [PMID: 29616496 PMCID: PMC5990997 DOI: 10.1007/s13244-018-0611-8] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 02/02/2018] [Accepted: 02/13/2018] [Indexed: 12/13/2022] Open
Abstract
Due to its superior sensitivity, breast MRI (bMRI) has been established as an important additional diagnostic tool in the breast clinic and is used for screening in patients with an elevated risk for breast cancer. Breast MRI, however, is a complex tool, providing multiple images containing several contrasts. Thus, reading bMRI requires a structured approach. A lack of structure will increase the rate of false-positive findings and sacrifice most of the advantages of bMRI as additional work-up will be required. While the BI-RADS (Breast Imaging Reporting And Data System) lexicon is a major step toward standardised and structured reporting, it does not provide a clinical decision rule with which to guide diagnostic decisions. Such a clinical decision rule, however, is provided by the Kaiser score, which combines five independent diagnostic BI-RADS lexicon criteria (margins, SI-time curve type, internal enhancement and presence of oedema) in an intuitive flowchart. The resulting score provides probabilities of malignancy that can be used for evidence-based decision-making in the breast clinic. Notably, considerable benefits have been demonstrated for radiologists with initial and intermediate experience in bMRI. This pictorial essay is a practical guide to the application of the Kaiser score in the interpretation of breast MRI examinations. TEACHING POINTS • bMRI requires standardisation of patient-management, protocols, and reading set-up. • Reading bMRI includes the assessment of breast parenchyma, associated findings, and lesions. • Diagnostic decisions should be made according to evidence-based clinical decision rules. • The evidence-based Kaiser score is applicable independent of bMRI protocol and scanner. • The Kaiser score provides high diagnostic accuracy with low inter-observer variability.
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Affiliation(s)
- Matthias Dietzel
- Department of Radiology, University Hospital Erlangen-Nürnberg, Maximiliansplatz 1, 91054, Erlangen, Germany
| | - Pascal A T Baltzer
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer-Guertel, 18-20, Vienna, Austria.
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Early Diagnosis of Breast Cancer: Public Health and Mammographic Screening. BIONANOSCIENCE 2018. [DOI: 10.1007/s12668-018-0504-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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