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

  • Aleksandr Istomin
    Affiliations
    Kuopio University Hospital, Diagnostic Imaging Center, Department of Clinical Radiology, Kuopio, Finland
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  • Amro Masarwah
    Affiliations
    Kuopio University Hospital, Diagnostic Imaging Center, Department of Clinical Radiology, Kuopio, Finland
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  • Ritva Vanninen
    Affiliations
    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
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  • Author Footnotes
    1 Shared authorship.
    Hidemi Okuma
    Footnotes
    1 Shared authorship.
    Affiliations
    Kuopio University Hospital, Diagnostic Imaging Center, Department of Clinical Radiology, Kuopio, Finland
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  • Author Footnotes
    1 Shared authorship.
    Mazen Sudah
    Correspondence
    Corresponding author at: Department of Clinical Radiology, Breast Unit, Kuopio University Hospital, Puijonlaaksontie 2, P.O. Box 100, FI-70029, Kuopio, Finland.
    Footnotes
    1 Shared authorship.
    Affiliations
    Kuopio University Hospital, Diagnostic Imaging Center, Department of Clinical Radiology, Kuopio, Finland

    University of Eastern Finland, Cancer Center of Eastern Finland, Kuopio, Finland
    Search for articles by this author
  • Author Footnotes
    1 Shared authorship.

      Highlights

      • The Kaiser score has high diagnostic accuracy in breast magnetic resonance imaging.
      • The interobserver agreement for the Kaiser score was excellent.
      • The use of the Kaiser score may reduce the biopsy rate for true negative lesions.

      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.

      Abbreviations:

      ADC (diffusion coefficient values), AUC (area under the curve), BI-RADS (Breast Imaging Reporting and Data System), CI (confidence intervals), EUSOMA (European Society of Breast Cancer Specialists working group), ICC (intraclass correlation coefficients), MCS (multiparametric classification system), MRI (magnetic resonance imaging), NME (non-mass enhancement), NPV (negative predictive values), PPV (positive predictive values), ROC (receiver operating characteristic)

      Keywords

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