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.
Institute of Diagnostic Radiology, University of Udine, Udine, Italy.
Eur Radiol. 2020 Nov;30(11):6052-6061. doi: 10.1007/s00330-020-06945-z. Epub 2020 Jun 6.
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.
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.
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.
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.
• 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.
MRI 是高风险患者乳腺癌筛查的一个组成部分。我们研究了在乳腺 MRI 筛查检查中，将凯萨评分（一种临床决策支持工具）应用于 BI-RADS 4 类增强病变是否可用于排除恶性肿瘤。
这项回顾性研究纳入了我们当地高危筛查计划中连续的 183 例经组织学证实的可疑（MR BI-RADS 4）病变。所有病变均由 3 位读者根据 Kaiser 评分进行评估，评分者对最终组织病理学诊断不知情。Kaiser 评分范围为 1（最低，癌症极不可能）至 11（最高，癌症极有可能），反映恶性肿瘤的可能性逐渐增加，评分大于 4 需进行活检。使用受试者工作特征（ROC）曲线分析评估诊断准确性。
159 例患者中共有 142 例良性病变和 41 例恶性病变，年龄中位数为 43.6 岁。良性病变的 Kaiser 评分中位数为 2 至 5，恶性病变的 Kaiser 评分中位数为 7 至 8。所有病变的 Kaiser 评分准确性（以曲线下面积 AUC 表示）为 86.5%至 90.2%。Kaiser 评分的敏感性高，所有病变的敏感性为 95.1%至 97.6%，在肿块病变中最佳。应用恶性肿瘤的 Kaiser 评分阈值（≤4）可能使之前分类为 BI-RADS 4 的 142 例良性病变中，有 64 例（45.1%）至 103 例（72.5%）避免了不必要的活检。
在高危 MRI 筛查中，Kaiser 评分可靠地排除了超过 45%的 BI-RADS 4 类增强病变的恶性肿瘤。
• Kaiser 评分在识别高危乳腺癌筛查中增强病变的恶性肿瘤方面具有较高的诊断准确性。• Kaiser 评分的应用可能避免 45%以上高危患者的不必要乳腺活检。• Kaiser 评分有助于高危乳腺癌 MRI 筛查计划中的决策制定。
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