Kaiser评分在乳腺非肿块强化病变诊断中的可行性研究

Kaiser score for diagnosis of breast lesions presenting as non-mass enhancement on MRI

目的评价Kaiser评分对乳腺非肿块强化病变的诊断效能。方法收集2014年1月~2019年6月术前行乳腺3.0 T MRI检查的非肿块强化患者资料,所有病例均经术后病理或穿刺活检证实。以病理结果为金标准,计算并比较Kaiser评分及BI-RADS分类对乳腺非肿块强化病变的诊断效能,比较2种方法诊断结果与病理结果的一致性。结果 88例患者共90个非肿块病灶,良性病变28个(31.1%),恶性病变62个(68.9%)。Kaiser评分诊断的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为100%、75%、89.9%、100%和92%;BI-RADS分类诊断的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为93.5%、46.4%、79.5%、76.5%和78.9%。Kaiser评分诊断特异性(75%)明显高于BI-RADS分类诊断(46.4%),差异有统计学意义(P=0.021)。结论 Kaiser评分系统可以为乳腺非肿块强化病变的BI-RADS分类提供诊断策略,对乳腺非肿块强化病变的诊断效能优于单纯应用BI-RADS分类。对于经验尚浅的影像科医师使用Kaiser评分能够明显提高乳腺非肿块病变的诊断特异性。

Objective To evaluate the diagnostic efficacy of Kaiser score for breast lesions presenting as non-mass enhancement.Methods We collected data from patients with breast lesions presenting as non-mass enhancement on preoperative DCE-MRI between January, 2014 and June, 2019. All the cases were confirmed by surgical pathology or puncture biopsy. With pathology results as the gold standard, we evaluated the diagnostic efficacy of Kaiser score and MRI BI-RADS classification and the consistency between the diagnostic results by the two methods and the pathological results. Results A total of 90 lesions were detected in 88 patients, including 28 benign lesions(31.1%) and 62 malignant lesions(68.9%). For diagnosis of the lesions, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of Kaiser Score were 100%, 75%, 89.9%,100% and 92%, as compared with 93.5%, 46.4%, 79.5%, 76.5% and 78.9% of MRI BI-RADS, respectively. The diagnostic specificity of Kaiser score was significantly higher than that of BI-RADS classification(P=0.021). Conclusion The Kaiser score system provides a diagnostic strategy for BI-RADS classification of breast lesions with non-mass enhancement and has a better diagnostic efficacy than BI-RADS classification alone. The use of Kaiser score can significantly improve the diagnostic specificity of such breast lesions for inexperienced radiologists.