Diagnostic performance of Kaiser score, ADC, and their combination for BI-RADS 4 breast lesions: subgroup and misclassification analysis.
Kaiser score diagnosed BI-RADS 4 breast lesions far better than apparent diffusion coefficient alone.
Diagnostic performance of Kaiser score, ADC, and their combination for BI-RADS 4 breast lesions: subgroup and misclassification analysis.
The Kaiser score and apparent diffusion coefficient (apparent diffusion coefficient) have been proposed as diagnostic adjuncts to reduce unnecessary biopsies in Breast Imaging Reporting and Data System (BI-RADS) 4 breast lesions.
To compare the diagnostic performance of the Kaiser score, apparent diffusion coefficient, and their combination (Kaiser+) stratified by lesion morphology, and to identify histopathologic subtypes most susceptible to misclassification.
This retrospective study included 222 patients with BI-RADS 4 breast lesions confirmed by histopathology.
Kaiser score identified breast cancer far more accurately than diffusion imaging alone
Kaiser demonstrated superior performance in mass lesions (AUC 0.926; 95% CI: 0.878-0.965) compared with non-mass enhancement (non-mass enhancement) (AUC 0.801; 95% CI: 0.681-0.905).
Pathology-stratified analysis revealed distinct misclassification patterns: fibroadenoma, breast hyperplasia, and intraductal papilloma accounted for most FP cases, with apparent diffusion coefficient showing significantly higher FP rates (66.1%; 95% CI: 57.3%-73.9%) than Kaiser (19.8%; 95% CI: 13.7%-27.8%) or Kaiser+ (17.4%; 95% CI: 11.6%-25.1%; p <0.001).
The Kaiser score outperformed apparent diffusion coefficient alone in BI-RADS 4 lesions.
Pathology-stratified analysis identified subtype-specific diagnostic pitfalls: benign cellular and proliferative lesions drive FP cases (especially with apparent diffusion coefficient), while low-conspicuity malignancies (ductal carcinoma in situ, mucinous carcinoma) drive FN cases.
Awareness of these patterns may guide individualized biopsy decisions in clinical practice.