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Breast lesions on MRI in mass and non-mass enhancement: Kaiser score and modified Kaiser score + for readers of variable experience

  • Breast
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To compare the diagnostic performance of three readers using BI-RADS and Kaiser score (KS) based on mass and non-mass enhancement (NME) lesions.

Methods

A total of 630 lesions, 393 malignant and 237 benign, 458 mass and 172 NME, were analyzed. Three radiologists with 3 years, 6 years, and 13 years of experience made diagnoses. 596 cases had diffusion-weighted imaging, and the apparent diffusion coefficient (ADC) was measured. For lesions with ADC > 1.4 × 10−3 mm2/s, the KS was reduced by 4 as the modified KS +, and the benefit was assessed.

Results

When using BI-RADS, AUC was 0.878, 0.915, and 0.941 for mass, and 0.771, 0.838, 0.902 for NME for Reader-1, 2, and 3, respectively, better for mass than for NME. The diagnostic accuracy of KS was improved compared to BI-RADS for less experienced readers. For Reader-1, AUC was increased from 0.878 to 0.916 for mass (p = 0.005) and from 0.771 to 0.822 for NME (p = 0.124). Based on the cut-off value of BI-RADS ≥ 4B and KS ≥ 5 as malignant, the sensitivity of KS by Readers-1 and -2 was significantly higher for both Mass and NME. When ADC was considered to change to modified KS +, the AUC and the accuracy for all three readers were improved, showing higher specificity with slightly degraded sensitivity.

Conclusion

The benefit of KS compared to BI-RADS was most noticeable for the less experienced readers in improving sensitivity. Compared to KS, KS + can improve specificity for all three readers. For NME, the KS and KS + criteria need to be further improved.

Clinical relevance statement

KS provides an intuitive method for diagnosing lesions on breast MRI. BI-RADS and KS face greater difficulties in evaluating NME compared to mass lesions. Adding ADC to the KS can improve specificity with slightly degraded sensitivity.

Key Points

  • KS provides an intuitive method for interpreting breast lesions on MRI, most helpful for novice readers.

  • KS, compared to BI-RADS, improved sensitivity in both mass and NME groups for less experienced readers.

  • NME lesions were considered during the development of the KS flowchart, but may need to be better defined.

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Abbreviations

ADC:

Apparent diffusion coefficient

AUC:

Area under ROC curve

BI-RADS:

Breast imaging and reporting data system

CI:

Confidence interval

DCE:

Dynamic contrast-enhanced

DWI:

Diffusion-weighted imaging

IQR:

Interquartile range

KS:

Kaiser score

NME:

Non-mass enhancement

ROC:

Receiver operating characteristic

ROI:

Region of interest

T2WI:

T2-weighted imaging

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Funding

This study was supported in part by the Research Incubation Project of First Affiliated Hospital of Wenzhou Medical University (no. FHY2019085), Wenzhou Science & Technology Bureau (no. Y20210232), Zhejiang Provincial Natural Science Foundation of China (LY21F020030), and Key Laboratory of Intelligent Medical Imaging of Wenzhou (no. 2021HZSY0057).

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Authors and Affiliations

  1. Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China

    Jiejie Zhou, Huiru Liu, Haiwei Miao, Shuxin Ye, Yun He, Youfan Zhao, Zhongwei Chen & Meihao Wang

  2. Department of Radiological Sciences, University of California, Irvine, CA, US

    Jiejie Zhou, Yang Zhang, Yan-Lin Liu & Min-Ying Su

  3. First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China

    Zhifang Pan

  4. Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan

    Min-Ying Su

  5. Key Laboratory of Intelligent Medical Imaging of Wenzhou, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China

    Meihao Wang

Authors
  1. Jiejie Zhou
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  2. Huiru Liu
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  3. Haiwei Miao
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  8. Yang Zhang
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  9. Yan-Lin Liu
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Corresponding authors

Correspondence to Min-Ying Su or Meihao Wang.

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Guarantor

The scientific guarantor of this publication is Min-Ying Su.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was waived.

Ethical approval

Institutional Review Board approval of First Affiliated Hospital of Wenzhou Medical University was obtained.

Study subjects or cohorts overlap

None of the subjects have been previously reported.

Methodology

  • Retrospective

  • Diagnostic study

  • Performed at one institution

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Zhou, J., Liu, H., Miao, H. et al. Breast lesions on MRI in mass and non-mass enhancement: Kaiser score and modified Kaiser score + for readers of variable experience. Eur Radiol (2024). https://doi.org/10.1007/s00330-024-10922-1

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  • DOI: https://doi.org/10.1007/s00330-024-10922-1

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