Abstract
ObjectivesTo 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 biopsiesMethodsThis 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.ResultsApplication 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.ConclusionsApplying 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.
Highlights
High Kaiser scores predict breast cancer with high specificity, aiding clinical decision-making with regard to re-biopsy in case of negative results
Calcifications detected on mammography are found in almost one-third of patients screened for breast cancer [1]
A search of eligible patients with suspicious calcifications on mammography, with no asymmetric densities, focal asymmetries, or mass lesions, and who were negative on sonography, and were undergoing further diagnostic workup with percutaneous breast biopsy or surgery was performed on the institutional database
Summary
Calcifications detected on mammography are found in almost one-third of patients screened for breast cancer [1]. While mammographic calcifications are considered an early indicator of breast cancer, in particular DCIS (ductal carcinoma in situ), not all biopsies yield malignant results. Mammographic calcifications regularly require further diagnostic workup with stereotactic-guided biopsy, a significant proportion of which yield benign findings, and could potentially be avoided [2,3,4]. While several reports have demonstrated a diagnostic role for breast MRI with regard to calcifications, its application in this setting has yielded variable results, and it is not yet recommended for this purpose [6,7,8]. The Kaiser score is such a decision-making tool and has demonstrated its usefulness in downgrading MRI-detected suspicious breast lesions through a formalized combination of the BI-RADS lexicon descriptors [9,10,11]
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