Department of Radiology, Tongde Hospital of Zhejiang Province, No. 234, Gucui Road, Xihu District, Hangzhou, 310012, Zhejiang Province, China.
Eur Radiol. 2022 Sep;32(9):5964-5973. doi: 10.1007/s00330-022-08674-x. Epub 2022 Mar 31.
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).
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 × 10mm/s, 1.4 × 10mm/s, 1.53 × 10mm/s, and 1.6 × 10mm/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.
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).
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.
• 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.
探讨弥散加权成像（DWI）作为 Kaiser 评分（KS）的附加手段，在乳腺磁共振成像（MRI）上对良恶性病变进行鉴别诊断的附加价值。
本回顾性研究纳入 2015 年 1 月至 2019 年 12 月期间 246 例患者的 273 个病灶（155 个恶性病灶）。所有病灶均经病理证实。两位对病理结果不知情的放射科医生根据 KS 对病灶进行评估。评分>4 的病灶被认为是恶性的。使用四个 ADC 值阈值（-1.3×10mm/s、1.4×10mm/s、1.53×10mm/s 和 1.6×10mm/s）来区分良性和恶性病灶。对于联合诊断，如果 KS>4 且 ADC 值低于预设的截断值，则认为该病灶为恶性；否则，该病灶为良性。比较 KS、DWI 和联合诊断之间的敏感性、特异性和曲线下面积（AUC）。
KS 的 AUC 显著高于 DWI 单独诊断（0.941 比 0.901，p=0.04）。KS（96.8%）和 DWI（97.4-99.4%）的敏感性相当（p>0.05），而 KS（83.9%）的特异性显著高于 DWI（19.5-56.8%）（p<0.05）。将 DWI 作为 KS 的附加手段，特异性增加了 0-2.5%，敏感性降低了 0.1-1.3%；然而，差异无统计学意义（p>0.05）。
KS 对乳腺良恶性病变的鉴别诊断优于 DWI 单独诊断。DWI 对 KS 鉴别乳腺病变没有额外的价值。
KS 对乳腺良恶性病变的鉴别诊断优于 DWI 单独诊断。
DWI 单独用于描述乳腺病变时具有很高的敏感性，但特异性较低。
联合使用 DWI 对 KS 并不能提高诊断性能。
