Kaiser score outperforms MRI BI-RADS for inconclusive breast findings

Kaiser scoring could support lesion stratification when used with MRI BI-RADS assessment, suggest findings published October 18 in the European Journal of Radiology. 

For breast lesions classified as BI-RADS 0 or 4 on mammography, the Kaiser score showed excellent diagnostic accuracy on breast MRI, wrote researchers led by Ece Zengin, MD, from Tokat Gaziosmanpaşa University in Türkiye. 

“Our findings indicate that the Kaiser score is a highly effective tool for differentiating benign from malignant breast lesions in patients with BI-RADS 0 or 4 findings on conventional imaging,” Zengin and colleagues wrote. 

BI-RADS 0 or 4 lesions may lead to unnecessary biopsies and more costs for patients and healthcare systems. The Kaiser score ranges between 1 (minimum risk) and 11 (maximum risk). It incorporates spiculations, breast MRI enhancement curves, margins, internal enhancement patterns, and edema into risk scoring. 

The Zengin team focused its study on the Kaiser score to predict malignancy in women who underwent breast MRI following inconclusive or suspicious imaging findings (BI-RADS 0 or 4), based on pathology results or clinical follow-up. 

The study included 99 women who underwent breast MRI between 2022 and 2024 due to inconclusive mammography and ultrasound results or suspicious findings. The women also had either histopathological evaluation following biopsy under ultrasound or mammography guidance or were followed for at least 12 months. The team divided the women into a benign (n = 66) and malignant cohort (n = 33). 

The team observed significant differences between both groups for the following patient-level factors: age (p 

Kaiser scoring showed strong diagnostic predictive value for malignancy when using a cutoff score of > 5, outperforming MRI BI-RADS with a cutoff value of > 4. 

In multivariable logistic regression, higher Kaiser score (odds ratio [OR] = 4.25, p 

The study authors suggested the Kaiser score’s higher performance in the study could be due to this approach’s integration of several morphologic and kinetic MRI features into a stepwise decision model. 

However, they added that the Kaiser score’s potential effect on biopsy decisions should be interpreted cautiously. 

“Biopsy decisions should remain based on integrated clinical and imaging findings,” the authors wrote. 

Read the full study here.