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Value of contrast-enhanced mammography combined with the Kaiser score for clinical decision-making regarding tomosynthesis BI-RADS 4A lesions

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Abstract

Objectives

To investigate the diagnostic performance of contrast-enhanced mammography (CEM) combined with the Kaiser score (KS) in digital breast tomosynthesis (DBT) BI-RADS 4A lesions to potentially reduce unnecessary breast biopsies.

Methods

This retrospective study evaluated 106 patients with 109 DBT BI-RADS 4A lesions from June 2019 to June 2021. For the absence of enhancement on CEM, the lesions were downgraded to BI-RADS 3. For lesions with enhancement, the readers were asked to classify all enhancing lesions referring to the KS for breast MRI. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic performance. Two readers rated all cases and interreader agreement was assessed by Cohen’s kappa coefficients.

Results

There were ninety-five benign lesions and 14 malignant lesions. CEM combined with KS’s accuracy, represented by the area under the curve (AUC), ranged between 0.880 and 0.906. The use of the KS improved the performance, with a significant difference relative to a single BI-RADS reading or US (p < 0.001). CEM with KS had higher specificity than CEM with BI-RADS or US (p < 0.001), without difference in sensitivity (p > 0.05). CEM combined with KS could have potentially obviated 72 (75.8%) to 78 (82.1%) unnecessary benign biopsies in 95 benign lesions previously DBT classified as BI-RADS 4A. The interreader agreement was substantial (kappa: 0.727) for KS.

Conclusions

CEM combined with KS may be used in DBT BI-RADS 4A lesions to substantially reduce unnecessary benign biopsies.

Key Points

• CEM combined with the Kaiser scoring system shows high diagnostic performance for DBT BI-RADS 4A lesions.

• The application of CEM combined with the Kaiser scoring system may avoid 75.8% to 82.1% of unnecessary benign breast biopsies.

• CEM combined with the KS aids clinical decision-making in DBT BI-RADS 4A lesions.

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Abbreviations

+LR:

Positive likelihood ratio

AUC:

Area under the curve

BI-RADS:

Breast Imaging-Reporting and Data System

CC:

Craniocaudal

CEM:

Contrast-enhanced mammography

KS:

Kaiser score

−LR:

Negative likelihood ratio

ROC:

Receiver operator characteristic

ROI:

Region of interest

US:

Ultrasound

References

  1. Sung H, Ferlay J, Siegel RL et al (2021) Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 71:209–249

    Article  Google Scholar 

  2. Tabár L, Yen AM, Wu WY et al (2015) Insights from the breast cancer screening trials: how screening affects the natural history of breast cancer and implications for evaluating service screening programs. Breast J 21:13–20

    Article  Google Scholar 

  3. Chong A, Weinstein SP, McDonald ES, Conant EF (2019) Digital breast tomosynthesis: concepts and clinical practice. Radiology 292:1–14

    Article  Google Scholar 

  4. D’Orsi CJ, Sickles EA, Mendelson EB et al (2013) ACR BI-RADS® atlas, breast imaging reporting and data system. Reston, American College of Radiology

    Google Scholar 

  5. Mann RM, Kuhl CK, Kinkel K, Boetes C (2008) Breast MRI: guidelines from the European Society of Breast Imaging. Eur Radiol 18:1307–1318

    Article  CAS  Google Scholar 

  6. Ghaderi KF, Phillips J, Perry H, Lotfi P, Mehta TS (2019) Contrast-enhanced mammography: current applications and future directions. Radiographics 39:1907–1920

    Article  Google Scholar 

  7. Fallenberg EM, Schmitzberger FF, Amer H et al (2017) Contrast-enhanced spectral mammography vs. mammography and MRI-clinical performance in a multi-reader evaluation. Eur Radiol 27:2752–2764

    Article  Google Scholar 

  8. Kim EY, Youn I, Lee KH et al (2018) Diagnostic value of contrast-enhanced digital mammography versus contrast-enhanced magnetic resonance imaging for the preoperative evaluation of breast cancer. J Breast Cancer 21:453–462

    Article  CAS  Google Scholar 

  9. Clauser P, Baltzer PAT, Kapetas P et al (2020) Low-dose contrast-enhanced mammography compared to contrast-enhanced breast MRI: a feasibility study. J Magn Reson Imaging 52:589–595

    Article  Google Scholar 

  10. Knogler T, Homolka P, Hoernig M et al (2017) Application of BI- RADS descriptors in contrast enhanced dual-energy mammography: comparison with MRI. Breast Care (Basel) 12:212–216

    Article  Google Scholar 

  11. Travieso-Aja MM, Maldonado-Saluzzi D, Naranjo-Santana P et al (2019) Evaluation of the applicability of BI-RADS® MRI for the interpretation of contrast-enhanced digital mammography. Radiologia 61:477–488

    Article  CAS  Google Scholar 

  12. Marino MA, Riedl CC, Bernathova M et al (2018) Imaging phenotypes in women at high risk for breast cancer on mammography, ultrasound, and magnetic resonance imaging using the fifth edition of the breast imaging reporting and data system. Eur J Radiol 106:150–159

    Article  Google Scholar 

  13. Dietzel M, Baltzer PAT (2018) How to use the Kaiser score as a clinical decision rule for diagnosis in multiparametric breast MRI: a pictorial essay. Insights Imaging 9:325–335

    Article  Google Scholar 

  14. Wengert GJ, Pipan F, Almohanna J et al (2020) Impact of the Kaiser score on clinical decision-making in BI-RADS 4 mammographic calcifications examined with breast MRI. Eur Radiol 30:1451–1459

    Article  CAS  Google Scholar 

  15. Milos RI, Pipan F, Kalovidouri A et al (2020) The Kaiser score reliably excludes malignancy in benign contrast-enhancing lesions classified as BI-RADS 4 on breast MRI high-risk screening exams. Eur Radiol 30:6052–6061

    Article  Google Scholar 

  16. Jochelson MS, Lobbes MBI (2021) Contrast-enhanced mammography: state of the art. Radiology 299:36–48

    Article  Google Scholar 

  17. Polat DS, Evans WP, Dogan BE (2020) Contrast-enhanced digital mammography: technique, clinical applications, and pitfalls. AJR Am J Roentgenol 215:1267–1278

    Article  Google Scholar 

  18. Rudnicki W, Heinze S, Niemiec J et al (2019) Correlation between quantitative assessment of contrast enhancement in contrast-enhanced spectral mammography (CESM) and histopathology- preliminary results. Eur Radiol 29:6220–6226

    Article  Google Scholar 

  19. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    Article  CAS  Google Scholar 

  20. Baltzer PA, Dietzel M, Kaiser WA (2013) A simple and robust classification tree for differentiation between benign and malignant lesions in MR-mammography. Eur Radiol 23:2051–2060

    Article  Google Scholar 

  21. Marino MA, Clauser P, Woitek R et al (2016) A simple scoring system for breast MRI interpretation: does it compensate for reader experience? Eur Radiol 26:2529–2537

    Article  Google Scholar 

  22. Woitek R, Spick C, Schernthaner M et al (2017) A simple classification system (the tree flowchart) for breast MRI can reduce the number of unnecessary biopsies in MRI-only lesions. Eur Radiol 27:3799–3809

    Article  Google Scholar 

  23. Ainakulova AS, Zholdybay ZZ, Kaidarova DR et al (2021) Contrast-enhanced spectral mammography without and with a delayed image for diagnosing malignancy among mass lesions in dense breast. Contemp Oncol (Pozn) 25:17–22

    Google Scholar 

  24. Huang JS, Pan HB, Yang TL et al (2020) Kinetic patterns of benign and malignant breast lesions on contrast enhanced digital mammogram. PLoS One 15:e0239271

  25. Zuley ML, Bandos AI, Abrams GS et al (2020) Contrast enhanced digital mammography (CEDM) helps to safely reduce benign breast biopsies for low to moderately suspicious soft tissue lesions. Acad Radiol 27:969–976

    Article  Google Scholar 

  26. Long R, Cao K, Cao M et al (2021) Improving the diagnostic accuracy of breast BI-RADS 4 microcalcification-only lesions using contrast-enhanced mammography. Clin Breast Cancer 21:256–262

    Article  Google Scholar 

  27. Istomin A, Masarwah A, Vanninen R, Okuma H, Sudah M (2021) Diagnostic performance of the Kaiser score for characterizing lesions on breast MRI with comparison to a multiparametric classification system. Eur J Radiol 138:109659

    Article  Google Scholar 

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Acknowledgements

I would like to express my gratitude to all those who helped me during the writing of this thesis. My deepest gratitude goes first and foremost to Professor Gaofeng Shi and Zhigang Li, for their encouragement and guidance.

Funding

This study has received funding from the Hebei Science and Technology Foundation (20377783D).

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Authors and Affiliations

  1. Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China

    Xiaocui Rong, Yihe Kang, Jing Xue, Pengyin Han, Zhigang Li & Guang Yang

  2. Department of Computed Tomography and Magnetic Resonance, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China

    Gaofeng Shi

Authors
  1. Xiaocui Rong
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  2. Yihe Kang
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  3. Jing Xue
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  4. Pengyin Han
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  5. Zhigang Li
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  6. Guang Yang
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  7. Gaofeng Shi
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Correspondence to Gaofeng Shi.

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Guarantor

The scientific guarantor of this publication is Gaofeng Shi.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

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Rong, X., Kang, Y., Xue, J. et al. Value of contrast-enhanced mammography combined with the Kaiser score for clinical decision-making regarding tomosynthesis BI-RADS 4A lesions. Eur Radiol 32, 7439–7447 (2022). https://doi.org/10.1007/s00330-022-08810-7

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  • DOI: https://doi.org/10.1007/s00330-022-08810-7

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