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European Radiology
Published in: European Radiology 11/2020

Open Access 01-11-2020 | Magnetic Resonance Imaging | Breast

The Kaiser score reliably excludes malignancy in benign contrast-enhancing lesions classified as BI-RADS 4 on breast MRI high-risk screening exams

Authors: Ruxandra Iulia Milos, Francesca Pipan, Anastasia Kalovidouri, Paola Clauser, Panagiotis Kapetas, Maria Bernathova, Thomas H. Helbich, Pascal A. T. Baltzer

Published in: European Radiology | Issue 11/2020

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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.
Appendix
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Metadata
Title
The Kaiser score reliably excludes malignancy in benign contrast-enhancing lesions classified as BI-RADS 4 on breast MRI high-risk screening exams
Authors
Ruxandra Iulia Milos
Francesca Pipan
Anastasia Kalovidouri
Paola Clauser
Panagiotis Kapetas
Maria Bernathova
Thomas H. Helbich
Pascal A. T. Baltzer
Publication date
01-11-2020
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 11/2020
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-020-06945-z

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