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Impact of the Kaiser score on clinical decision-making in BI-RADS 4 mammographic calcifications examined with breast MRI.
Eur Radiol. 2020 Mar; 30(3):1451-1459.ER

Abstract

OBJECTIVES

To investigate whether the application of the Kaiser score for breast magnetic resonance imaging (MRI) might downgrade breast lesions that present as mammographic calcifications and avoid unnecessary breast biopsies METHODS: This IRB-approved, retrospective, cross-sectional, single-center study included 167 consecutive patients with suspicious mammographic calcifications and histopathologically verified results. These patients underwent a pre-interventional breast MRI exam for further diagnostic assessment before vacuum-assisted stereotactic-guided biopsy (95 malignant and 72 benign lesions). Two breast radiologists with different levels of experience independently read all examinations using the Kaiser score, a machine learning-derived clinical decision-making tool that provides probabilities of malignancy by a formalized combination of diagnostic criteria. Diagnostic performance was assessed by receiver operating characteristics (ROC) analysis and inter-reader agreement by the calculation of Cohen's kappa coefficients.

RESULTS

Application of the Kaiser score revealed a large area under the ROC curve (0.859-0.889). Rule-out criteria, with high sensitivity, were applied to mass and non-mass lesions alike. The rate of potentially avoidable breast biopsies ranged between 58.3 and 65.3%, with the lowest rate observed with the least experienced reader.

CONCLUSIONS

Applying the Kaiser score to breast MRI allows stratifying the risk of breast cancer in lesions that present as suspicious calcifications on mammography and may thus avoid unnecessary breast biopsies.

KEY POINTS

• The Kaiser score is a helpful clinical decision tool for distinguishing malignant from benign breast lesions that present as calcifications on mammography. • Application of the Kaiser score may obviate 58.3-65.3% of unnecessary stereotactic biopsies of suspicious calcifications. • High Kaiser scores predict breast cancer with high specificity, aiding clinical decision-making with regard to re-biopsy in case of negative results.

Authors+Show Affiliations

Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria.Institute of Diagnostic Radiology, University of Udine, Udine, Italy.Security Forces Hospital, Riyadh, Saudi Arabia.Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria.Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria.Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria.Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria.Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria. Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria.Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria. pascal.baltzer@meduniwien.ac.at.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31797077

Citation

Wengert, G J., et al. "Impact of the Kaiser Score On Clinical Decision-making in BI-RADS 4 Mammographic Calcifications Examined With Breast MRI." European Radiology, vol. 30, no. 3, 2020, pp. 1451-1459.
Wengert GJ, Pipan F, Almohanna J, et al. Impact of the Kaiser score on clinical decision-making in BI-RADS 4 mammographic calcifications examined with breast MRI. Eur Radiol. 2020;30(3):1451-1459.
Wengert, G. J., Pipan, F., Almohanna, J., Bickel, H., Polanec, S., Kapetas, P., Clauser, P., Pinker, K., Helbich, T. H., & Baltzer, P. A. T. (2020). Impact of the Kaiser score on clinical decision-making in BI-RADS 4 mammographic calcifications examined with breast MRI. European Radiology, 30(3), 1451-1459. https://doi.org/10.1007/s00330-019-06444-w
Wengert GJ, et al. Impact of the Kaiser Score On Clinical Decision-making in BI-RADS 4 Mammographic Calcifications Examined With Breast MRI. Eur Radiol. 2020;30(3):1451-1459. PubMed PMID: 31797077.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of the Kaiser score on clinical decision-making in BI-RADS 4 mammographic calcifications examined with breast MRI. AU - Wengert,G J, AU - Pipan,F, AU - Almohanna,J, AU - Bickel,H, AU - Polanec,S, AU - Kapetas,P, AU - Clauser,P, AU - Pinker,K, AU - Helbich,T H, AU - Baltzer,P A T, Y1 - 2019/12/03/ PY - 2019/04/30/received PY - 2019/09/09/accepted PY - 2019/08/05/revised PY - 2019/12/5/pubmed PY - 2020/9/24/medline PY - 2019/12/5/entrez KW - Breast cancer KW - Calcifications KW - Clinical decision-making KW - Magnetic resonance imaging KW - Scoring system SP - 1451 EP - 1459 JF - European radiology JO - Eur Radiol VL - 30 IS - 3 N2 - OBJECTIVES: To investigate whether the application of the Kaiser score for breast magnetic resonance imaging (MRI) might downgrade breast lesions that present as mammographic calcifications and avoid unnecessary breast biopsies METHODS: This IRB-approved, retrospective, cross-sectional, single-center study included 167 consecutive patients with suspicious mammographic calcifications and histopathologically verified results. These patients underwent a pre-interventional breast MRI exam for further diagnostic assessment before vacuum-assisted stereotactic-guided biopsy (95 malignant and 72 benign lesions). Two breast radiologists with different levels of experience independently read all examinations using the Kaiser score, a machine learning-derived clinical decision-making tool that provides probabilities of malignancy by a formalized combination of diagnostic criteria. Diagnostic performance was assessed by receiver operating characteristics (ROC) analysis and inter-reader agreement by the calculation of Cohen's kappa coefficients. RESULTS: Application of the Kaiser score revealed a large area under the ROC curve (0.859-0.889). Rule-out criteria, with high sensitivity, were applied to mass and non-mass lesions alike. The rate of potentially avoidable breast biopsies ranged between 58.3 and 65.3%, with the lowest rate observed with the least experienced reader. CONCLUSIONS: Applying the Kaiser score to breast MRI allows stratifying the risk of breast cancer in lesions that present as suspicious calcifications on mammography and may thus avoid unnecessary breast biopsies. KEY POINTS: • The Kaiser score is a helpful clinical decision tool for distinguishing malignant from benign breast lesions that present as calcifications on mammography. • Application of the Kaiser score may obviate 58.3-65.3% of unnecessary stereotactic biopsies of suspicious calcifications. • High Kaiser scores predict breast cancer with high specificity, aiding clinical decision-making with regard to re-biopsy in case of negative results. SN - 1432-1084 UR - https://www.unboundmedicine.com/medline/citation/31797077/Impact_of_the_Kaiser_score_on_clinical_decision_making_in_BI_RADS_4_mammographic_calcifications_examined_with_breast_MRI_ L2 - https://dx.doi.org/10.1007/s00330-019-06444-w DB - PRIME DP - Unbound Medicine ER -