Using the Kaiser Score as a clinical decision rule for breast lesion classification: Does computer-assisted curve type analysis improve diagnosis?

•The Kaiser Score is not statistically significant by the way enhancement curve type is assessed.•There was a non-significant trend towards higher diagnostic accuracy using parametric maps.•Using parametric maps avoided 3 FN cancer diagnoses without any vice versa cases. We aimed to investigate the...

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Published in:European journal of radiology 2024-01, Vol.170, p.111271-111271, Article 111271
Main Authors: Pötsch, N., Vatteroni, G., Clauser, P., Rainer, E., Kapetas, P., Milos, R., Helbich, T.H., Baltzer, P.
Format: Article
Language:English
Subjects:
Breast - pathology
Breast neoplasms
Breast Neoplasms - pathology
Clinical decision rule
Clinical Decision Rules
Computers
Contrast Media
Female
Humans
Kinetics
Magnetic Resonance Imaging - methods
MRI
Retrospective Studies
ROC Curve
Sensitivity and Specificity
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Summary:•The Kaiser Score is not statistically significant by the way enhancement curve type is assessed.•There was a non-significant trend towards higher diagnostic accuracy using parametric maps.•Using parametric maps avoided 3 FN cancer diagnoses without any vice versa cases. 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. 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. 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). 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.
ISSN:0720-048X
1872-7727
DOI:10.1016/j.ejrad.2023.111271