Clinical management of patients with suspected breast-cancer: A multicentric comparison of Apparent Diffusion Coefficient Mapping (ADC) and the Kaiser Score (KS)

Objective Evidence-based decision-rules such as ADC and KS support clinical management of patients with suspected breast-cancer. We compared ADC and KS in distinguishing benign from malignant breast lesion.

Methods In this multicentric-study, consecutive patients from three centers receiving standardized breast-MRI for non-screening indications were included. Two radiologists (>5 years experience) retrospectively interpreted the examinations in consensus.

The KS was applied to every histologically verified lesion and the corresponding mean ADC was measured (Wielema type 4).

Diagnostic accuracy was evaluated by ROC curves and compared between KS, and ADC (DeLong test). Likewise the potential to help avoid unnecessary biopsies was compared based on established high-sensitivity thresholds (McNemar test).

Results A total of 450 lesions in 414 patients (mean-age: 51.5years) were included (malignant: 219 lesions; 48.7 %). The performance of the KS (AUC, 0.915; CI, 0.886-0.939) was significantly better than the ADC (ROC, 0.848; CI, 0.811-0.880; P< 0.001).The KS and ADC achieved equal sensitivity (both: 97.7 %). The rate of avoidable biopsies was higher when using the KS (specificity: 65.4 % vs 32.9 %; P < 0.0001).

Conclusions The KS proved superior to the ADC and significantly reduced the number of unnecessary biopsies. Thus the KS may improve clinical management of patients with suspected breast-cancer.

Fig.1 Comparison of ADC and KS for the management of patients with suspected breast-cance

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Publication History

Article published online:
01 June 2021