Abstract
ObjectivesMRI 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.MethodsThis 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.ResultsThere 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.ConclusionsThe 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.
Highlights
MRI provides the highest sensitivity for the detection of breast cancer [1,2,3,4,5] and it plays a central role in the screening of patients with a hereditary or familial high-risk for developing breast cancer [6]
This study investigated the benefit of implementing the Kaiser score as a decision tool in MRI suspicious (BI-RADS 4) contrast-enhancing lesions diagnosed in patients at high-risk for developing breast cancer
This is clinically highly relevant as it refutes the notion of benign-appearing cancers in the investigated setting
Summary
MRI provides the highest sensitivity for the detection of breast cancer [1,2,3,4,5] and it plays a central role in the screening of patients with a hereditary or familial high-risk for developing breast cancer [6]. Women at an increased risk for the development of breast cancer are usually prone to develop breast cancer at a much younger age [7] and are screened from a younger age and for a longer period of time. These patients usually undergo multimodality screening, it has been shown that MRI is the best modality with which to detect familial breast cancer, regardless of patient age, breast density, or risk status [9, 10]. The BI-RADS lexicon can be used to describe enhancing breast lesions in a standardized and commonly understandable way
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