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• Clinical Article •
Study on the differential diagnostic efficacy of Kaiser score and apparent diffusion coefficient values for benign and malignant breast lesions during lactation
YANG Zhexuan  ZHAO Xin  TAN Shifang  CHENG Meiying  SHEN Yanyong  ZHANG Xiaoxue  FENG Zhanqi  WANG Changhao 

Cite this article as: YANG Z X, ZHAO X, TAN S F, et al. Study on the differential diagnostic efficacy of Kaiser score and apparent diffusion coefficient values for benign and malignant breast lesions during lactation[J]. Chin J Magn Reson Imaging, 2024, 15(6): 87-93. DOI:10.12015/issn.1674-8034.2024.06.013.


[Abstract] Objective To evaluate the diagnostic performance of Kaiser score and apparent diffusion coefficient (ADC) in the differential diagnosis of benign and malignant breast lesions during lactation.Materials and Methods This retrospective study enrolled 65 patients who underwent breast MRI in the Third Affiliated Hospital of Zhengzhou University from October 2016 to October 2023. The clinical, pathological and imaging data of 65 patients were collected. According to the pathological results, the cases were divided into malignant group (31 cases) and benign group (34 cases). One primary lesion was selected from each patient for Kaiser score and ADC value measurement. Lesions with Kaiser scores greater than 4 were reevaluated based on their ADC values, and new predictive indicator Kaiser+ were obtained. Using pathological results as the gold standard, and receiver operating characteristic (ROC) curve was used to compare the diagnostic accuracy of ADC value. Calculated the area under the curve (AUC), sensitivity, specificity, and accuracy, and compared the AUC of the three using DeLong test.Results The AUC of ADC value was 0.818 [95% confidence interval (CI): 0.709-0.927]. The AUC of Kaiser score was 0.881 (95% CI: 0.791-0.971). The AUC of Kaiser+ score was 0.910 (95% CI: 0.931-0.990). The AUC between Kaiser+ score and ADC value was statistically significant (0.910 vs. 0.818, P=0.011). There was no significant difference in AUC between Kaiser score and ADC value (0.881 vs. 0.818, P=0.141), and there was no significant difference in AUC between Kaiser+ score and Kaiser score (0.910 vs. 0.881, P=0.151).Conclusions Kaiser+ score has higher diagnostic efficiency than ADC value, which can accurately identify benign and malignant breast lesions during lactation and provide reference for clinical development of personalized treatment plans.
[Keywords] breast cancer during lactation；differential diagnosis；Kaiser score；apparent diffusion coefficient；magnetic resonance imaging

YANG Zhexuan1, 2   ZHAO Xin1, 2   TAN Shifang1   CHENG Meiying1, 2*   SHEN Yanyong1   ZHANG Xiaoxue1   FENG Zhanqi1   WANG Changhao1  

1 Medical Imaging Department, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China

2 Tianjian Laboratory of Advanced Biomedical Sciences, Institute of Advanced Biomedical Sciences, Zhengzhou 450052, China

Corresponding author: CHENG M Y, E-mail: chengmysfy@zzu.edu.cn

Conflicts of interest   None.

Received  2024-01-11
Accepted  2024-05-21
DOI: 10.12015/issn.1674-8034.2024.06.013
Cite this article as: YANG Z X, ZHAO X, TAN S F, et al. Study on the differential diagnostic efficacy of Kaiser score and apparent diffusion coefficient values for benign and malignant breast lesions during lactation[J]. Chin J Magn Reson Imaging, 2024, 15(6): 87-93. DOI:10.12015/issn.1674-8034.2024.06.013.

[1]
SIEGEL R, GIAQUINTO A N, JEMAL A. Cancer statistics, 2024[J]. CA Cancer J Clin, 2024, 74(1): 12-49. DOI: 10.3322/caac.21820.
[2]
XU K L, CHUNG M, HAYWARD J H, et al. MRI of the lactating breast[J/OL]. Radiographics, 2024, 44(2): e230129 [2024-01-10]. https://pubmed.ncbi.nlm.nih.gov/38300813/. DOI: 10.1148/rg.230129.
[3]
BALTZER P A T, DIETZEL M, KAISER W A. A simple and robust classification tree for differentiation between benign and malignant lesions in MR-mammography[J]. Eur Radiol, 2013, 23(8): 2051-2060. DOI: 10.1007/s00330-013-2804-3.
[4]
DIETZEL M, BALTZER P A T. How to use the Kaiser score as a clinical decision rule for diagnosis in multiparametric breast MRI: a pictorial essay[J]. Insights Imaging, 2018, 9(3): 325-335. DOI: 10.1007/s13244-018-0611-8.
[5]
DIETZEL M, BERNATHOVA M, CLAUSER P, et al. Added value of clinical decision rules for the management of enhancing breast MRI lesions: a systematic comparison of the Kaiser score and the Göttingen score[J/OL]. Eur J Radiol, 2023, 169: 111185 [2024-01-10]. https://pubmed.ncbi.nlm.nih.gov/37939606/. DOI: 10.1016/j.ejrad.2023.111185.
[6]
CHEN Z W, ZHAO Y F, LIU H R, et al. Assessment of breast lesions by the Kaiser score for differential diagnosis on MRI: the added value of ADC and machine learning modeling[J]. Eur Radiol, 2022, 32(10): 6608-6618. DOI: 10.1007/s00330-022-08899-w.
[7]
WANG H J, WANG W W, LÜ S Q, et al. Value of multi-parameter diffusion weighted imaging in the differential diagnosis of benign and malignant TIC type Ⅱ breast lesions[J]. Chin J Magn Reson Imag, 2022, 13(9): 18-24. DOI: 10.12015/issn.1674-8034.2022.09.004.
[8]
YOU X G, REN H Y, WEN L J. DWI-MRI combined with HE4 and SCC-Ag in diagnosis of benign and malignant ovarian tumors[J]. China J Mod Med, 2021, 31(15): 54-59. DOI: 10.3969/j.issn.1005-8982.2021.15.010.
[9]
JIANG K K, HONG R X, XIA W, et al. Clinicopathologic characteristics, diagnosis and treatment of pregnancy-associated breast cancer: a retrospective analysis of 85 cases[J/OL]. Chin J Breast Dis Electron Ed, 2021, 15(1): 24-29 [2024-01-10]. https://d.wanfangdata.com.cn/periodical/zhrxbzz202101005. DOI: 10.3877/cma.j.issn.1674-0807.2021.01.005.
[10]
MATAR R, CROWN A, SEVILIMEDU V, et al. Timing of presentation and outcomes of women with stage Ⅳ pregnancy-associated breast cancer (PABC)[J]. Ann Surg Oncol, 2022, 29(3): 1695-1702. DOI: 10.1245/s10434-021-10901-6.
[11]
BOERE I, LOK C, POORTMANS P, et al. Breast cancer during pregnancy: epidemiology, phenotypes, presentation during pregnancy and therapeutic modalities[J/OL]. Best Pract Res Clin Obstet Gynaecol, 2022, 82: 46-59 [2024-01-10]. https://pubmed.ncbi.nlm.nih.gov/35644793/. DOI: 10.1016/j.bpobgyn.2022.05.001.
[12]
MILOS R I, PIPAN F, KALOVIDOURI A, et al. The Kaiser score reliably excludes malignancy in benign contrast-enhancing lesions classified as BI-RADS 4 on breast MRI high-risk screening exams[J]. Eur Radiol, 2020, 30(11): 6052-6061. DOI: 10.1007/s00330-020-06945-z.
[13]
PAN J L, LI X H, CHEN X J, et al. A comparison of the Kaiser score and apparent diffusion coefficient mapping in the assessment of breast lesions[J]. Chin J Magn Reson Imag, 2022, 13(6): 108-111, 116. DOI: 10.12015/issn.1674-8034.2022.06.021.
[14]
WOITEK R, SPICK C, SCHERNTHANER M, et al. A simple classification system (the Tree flowchart) for breast MRI can reduce the number of unnecessary biopsies in MRI-only lesions[J]. Eur Radiol, 2017, 27(9): 3799-3809. DOI: 10.1007/s00330-017-4755-6.
[15]
WANG Q B, FU F L, CHEN Y, et al. Application of the Kaiser score by MRI in patients with breast lesions by ultrasound and mammography[J]. Diagn Interv Radiol, 2022, 28(4): 322-328. DOI: 10.5152/dir.2022.201075.
[16]
DU L, ZHANG R X, XU K P, et al. Clinical value of Kaiser score in diagnosis of sub-centimeter breast masses of BI-RADS Category 4 by MRI[J]. Chin Imag J Integr Tradit West Med, 2023, 21(6): 656-662. DOI: 10.3969/j.issn.1672-0512.2023.06.012.
[17]
WANG H, GAO L, CHEN X, et al. Quantitative evaluation of Kaiser score in diagnosing breast dynamic contrast-enhanced magnetic resonance imaging for patients with high-grade background parenchymal enhancement[J]. Quant Imaging Med Surg, 2023, 13(10): 6384-6394. DOI: 10.21037/qims-23-113.
[18]
MENG L S, ZHAO X, GUO J X, et al. Improved differential diagnosis based on BI-RADS descriptors and apparent diffusion coefficient for breast lesions: a multiparametric MRI analysis as compared to Kaiser score[J/OL]. Acad Radiol, 2023, 30(Suppl 2): S93-S103 [2024-01-10]. https://pubmed.ncbi.nlm.nih.gov/37236897/. DOI: 10.1016/j.acra.2023.03.035.
[19]
CHEN Y M, ZHAO L, GUO J, et al. Study on the value of magnetic resonance imaging in breast cancer during lactation[J]. Jiangxi Med J, 2021, 56(9): 1346-1348. DOI: 10.3969/j.issn.1006-2238.2021.09.010.
[20]
VASHI R, HOOLEY R, BUTLER R, et al. Breast imaging of the pregnant and lactating patient: physiologic changes and common benign entities[J]. AJR Am J Roentgenol, 2013, 200(2): 329-336. DOI: 10.2214/AJR.12.9845.
[21]
PETERSON M S, GEGIOS A R, ELEZABY M A, et al. Breast imaging and intervention during pregnancy and lactation[J/OL]. Radiographics, 2023, 43(10): e230014 [2024-01-10]. https://pubmed.ncbi.nlm.nih.gov/37708073/. DOI: 10.1148/rg.230014.
[22]
WANG L J, FENG H, PAN J Y, et al. Diagnostic value of multimodal MR in differentiating fibroadenoma from phyllodes tumor with maximum diameter≥5 cm[J]. J Pract Radiol, 2024, 40(3): 377-380, 410. DOI: 10.3969/j.issn.1002-1671.2024.03.008.
[23]
BASARA AKIN I, BALCI P. Fibroadenomas: a multidisciplinary review of the variants[J/OL]. Clin Imaging, 2021, 71: 83-100 [2024-01-10]. https://pubmed.ncbi.nlm.nih.gov/33186871/. DOI: 10.1016/j.clinimag.2020.10.058.
[24]
MAGLIONE K D, LEE A Y, RAY K M, et al. Radiologic-pathologic correlation for benign results after MRI-guided breast biopsy[J]. AJR Am J Roentgenol, 2017, 209(2): 442-453. DOI: 10.2214/AJR.16.17048.
[25]
LIU J N, DONG Y, YU T. Magnetic resonance imaging to differentiate sclerosing adenosis of breast from infiltrating ductal carcinoma[J]. Chin J CT MRI, 2023, 21(4): 98-100. DOI: 10.3969/j.issn.1672-5131.2023.04.034.
[26]
OKTAY A, ASLAN Ö, TAŞKıN F, et al. Outcomes of high-risk breast lesions diagnosed using image-guided core needle biopsy: results from a multicenter retrospective study[J]. Diagn Interv Radiol, 2023, 29(4): 579-587. DOI: 10.4274/dir.2022.221790.
[27]
WU Q, WANG Z, KANG J Y, et al. Imaging manifestations and research progress of sclerosing adenosis of breast[J]. Chin J Magn Reson Imag, 2021, 12(10): 101-104. DOI: 10.12015/issn.1674-8034.2021.10.026.
[28]
ZHU D, QIAN H S, HAN H X, et al. MRI differential diagnosis of breast adenosis and breast ductal carcinomawithpathologicalcorrelation[J]. Chin J Magn Reson Imag, 2017, 8(10): 753-759. DOI: 10.12015/issn.1674-8034.2017.10.007.
[29]
ASLAN O, OKTAY A. Diagnostic accuracy of the breast MRI Kaiser score in suspected architectural distortions and its comparison with mammography[J/OL]. Sci Rep, 2024, 14(1): 447 [2024-01-10]. https://pubmed.ncbi.nlm.nih.gov/38172557/. DOI: 10.1038/s41598-023-50798-7.
[30]
GUO J L, LIU H, HUANG X B, et al. The application value of MR dynamic enhancement TIC curve combined with apparent dispersion coefficient in benign and malignant breast lesions[J]. Chin J CT MRI, 2022, 20(9): 97-98. DOI: 1672-5131.2022.09.036.
[31]
LI H Y, ZHANG Y Z, LIU P, et al. Dynamic contrast-enhanced magnetic resonance imaging combined with multi-b value diffusion weighted imaging in the diagnosis of breast cancer[J]. Chin J Med Imag, 2019, 27(12): 901-904. DOI: 10.3969/j.issn.1005-5185.2019.12.005.
[32]
SHI Q F, DING J M, ZHAO Y. Clinical value of DCE-MRI combined with DWI in the diagnosis of benign and malignant breast lesions[J]. Chin J CT MRI, 2023, 21(4): 88-90. DOI: 10.3969/j.issn.1672-5131.2023.04.031.
[33]
WANG L, ZHAO F, ZHU L M, et al. The value of multimodal magnetic resonance imaging in the differential diagnosis of benign and malignant breast lesions[J]. J Clin Radiol, 2023, 42(10): 1578-1583. DOI: 10.13437/j.cnki.jcr.2023.10.015.
[34]
LU X Y, GUO J L, LIU H. Application value of MR dynamic enhancement in the diagnosis of benign and malignant breast lesions[J]. Chin J CT MRI, 2020, 18(11): 53-54, 80. DOI: 10.3969/j.issn.1672-5131.2020.11.017.
[35]
AN Y Y, MAO G Q, AO W Q, et al. Can DWI provide additional value to Kaiser score in evaluation of breast lesions[J]. Eur Radiol, 2022, 32(9): 5964-5973. DOI: 10.1007/s00330-022-08674-x.
[36]
DIETZEL M, KRUG B, CLAUSER P, et al. A multicentric comparison of apparent diffusion coefficient mapping and the Kaiser score in the assessment of breast lesions[J]. Invest Radiol, 2021, 56(5): 274-282. DOI: 10.1097/RLI.0000000000000739.

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