Universität zu Köln

Dietzel, Matthias, Krug, Barbara, Clauser, Paola, Burke, Christina, Hellmich, Martin ORCID: 0000-0001-5174-928X, Maintz, David, Uder, Michael, Bickel, Hubert, Helbich, Thomas and Baltzer, Pascal A. T. (2021). A Multicentric Comparison of Apparent Diffusion Coefficient Mapping and the Kaiser Score in the Assessment of Breast Lesions. Invest. Radiol., 56 (5). S. 274 - 283. PHILADELPHIA: LIPPINCOTT WILLIAMS & WILKINS. ISSN 1536-0210

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Abstract

Objective We sought to compare the diagnostic performance of apparent diffusion coefficient (ADC) mapping with the Kaiser score (KS) to distinguish benign from malignant breast lesions and to assess the potential of this approach to help avoid unnecessary biopsies. Materials and Methods In this multicentric study, individual patient data from 3 different centers were analyzed. Consecutive patients receiving standardized multiparametric breast magnetic resonance imaging for standard nonscreening indications were included. At each center, 2 experienced radiologists with more than 5 years of experience retrospectively interpreted the examinations in consensus and applied the KS to every histologically verified lesion. The corresponding mean ADC of each lesion was measured using a Wielema type 4 region of interest. According to established methods, the KS and ADC were combined, yielding the KS+ score. Diagnostic accuracy was evaluated by the area under the receiver operating characteristics curve (AUROC) and compared between the KS, ADC, and KS+ (DeLong test). Likewise, the potential to help avoid unnecessary biopsies was compared between the KS, ADC, and KS+ based on established high sensitivity thresholds (McNemar test). Results A total of 450 lesions in 414 patients (mean age, 51.5 years; interquartile range, 42-60.8 years) were included, with 219 lesions being malignant (48.7%; 95% confidence interval [CI], 44%-53.4%). The performance of the KS (AUROC, 0.915; CI, 0.886-0.939) was significantly better than that of the ADC (AUROC, 0.848; CI, 0.811-0.880; P < 0.001). The largest difference between these parameters was observed when assessing subcentimeter lesions (AUROC, 0.909 for KS; CI, 0.849-0.950 vs 0.811 for ADC; CI, 0.737-0.871; P = 0.02). The use of the KS+ (AUROC, 0.918; CI, 0.889-0.942) improved the performance slightly, but without any significant difference relative to a single KS or ADC reading (P = 0.64). When applying high sensitivity thresholds for avoiding unnecessary biopsies, the KS and ADC achieved equal sensitivity (97.7% for both; cutoff values, >4 for KS and <= 1.4 x 10(-3) mm(2)/s for ADC). However, the rate of potentially avoidable biopsies was higher when using the KS (specificity: 65.4% for KS vs 32.9% for ADC; P < 0.0001). The KS was superior to the KS+ in avoiding unnecessary biopsies. Conclusions Both the KS and ADC may be used to distinguish benign from malignant breast lesions. However, KS proved superior in this task including, most of all, when assessing small lesions less than 1 cm. Using the KS may avoid twice as many unnecessary biopsies, and the combination of both the KS and ADS does not improve diagnostic performance.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Dietzel, Matthias UNSPECIFIED UNSPECIFIED UNSPECIFIED Krug, Barbara UNSPECIFIED UNSPECIFIED UNSPECIFIED Clauser, Paola UNSPECIFIED UNSPECIFIED UNSPECIFIED Burke, Christina UNSPECIFIED UNSPECIFIED UNSPECIFIED Hellmich, Martin UNSPECIFIED orcid.org/0000-0001-5174-928X UNSPECIFIED Maintz, David UNSPECIFIED UNSPECIFIED UNSPECIFIED Uder, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Bickel, Hubert UNSPECIFIED UNSPECIFIED UNSPECIFIED Helbich, Thomas UNSPECIFIED UNSPECIFIED UNSPECIFIED Baltzer, Pascal A. T. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-578216
DOI:	10.1097/RLI.0000000000000739
Journal or Publication Title:	Invest. Radiol.
Volume:	56
Number:	5
Page Range:	S. 274 - 283
Date:	2021
Publisher:	LIPPINCOTT WILLIAMS & WILKINS
Place of Publication:	PHILADELPHIA
ISSN:	1536-0210
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language Radiology, Nuclear Medicine & Medical Imaging Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/57821