ArticleEuropean radiology2017
A simple classification system (the Tree flowchart) for breast MRI can reduce the number of unnecessary biopsies in MRI-only lesions.
Article in European radiology, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 33 papers, 2 of them syntheses that pooled it.
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Who cites it
33 citing papers in PubMed, 2 syntheses or guidelines pooled it, 79 citations in OpenAlex.
- Can structured integration of BI-RADS criteria by a clinical decision rule reduce the number of unnecessary biopsies in BI-RADS 4 lesions? A systematic review and meta-analysis.European radiology · 2025Pooled it
- Breast lesions classified as probably benign (BI-RADS 3) on magnetic resonance imaging: a systematic review and meta-analysis.European radiology · 2018Pooled it
- Diagnostic Performance of Kaiser Score for Characterization of Breast Lesions on Modified Abbreviated Breast MRI and Comparison with Full-Protocol Breast MRI.Journal of clinical medicine · 2025Article
- External validation of multiparametric magnetic resonance imaging-based decision rules for characterizing breast lesions and comparison to Kaiser score and breast imaging reporting and data system (BI-RADS) category.Quantitative imaging in medicine and surgery · 2025Article
- Breast lesions on MRI in mass and non-mass enhancement: Kaiser score and modified Kaiser score + for readers of variable experience.European radiology · 2025Article
- Temporal and masseter muscle evaluation by MRI provides information on muscle mass and quality in acromegaly patients.Pituitary · 2024Article
- Reliability of Kaiser Score in Assessing Additional Breast Lesions Identified on Staging MRI in Patients with Breast Cancer.Diagnostics (Basel, Switzerland) · 2024Article
- Application of the Kaiser score on contrast-enhanced mammography in the differential diagnosis of breast lesions: comparison with breast magnetic resonance imaging.Quantitative imaging in medicine and surgery · 2024Article
- Unveiling the potential of breast MRI: a game changer for BI-RADS 4A microcalcifications.Breast cancer research and treatment · 2024Article
- Quantitative evaluation of Kaiser score in diagnosing breast dynamic contrast-enhanced magnetic resonance imaging for patients with high-grade background parenchymal enhancement.Quantitative imaging in medicine and surgery · 2023Article
- Breast MRI: an illustration of benign findings.The British journal of radiology · 2023Review
- Diagnostic value of Kaiser score combined with breast vascular assessment from breast MRI for the characterization of breast lesions.Frontiers in oncology · 2023Article
- Combination of ultrafast dynamic contrast-enhanced MRI-based radiomics and artificial neural network in assessing BI-RADS 4 breast lesions: Potential to avoid unnecessary biopsies.Frontiers in oncology · 2023Article
- Can DWI provide additional value to Kaiser score in evaluation of breast lesions.European radiology · 2022Article
- A simplified scoring protocol to improve diagnostic accuracy with the breast imaging reporting and data system in breast magnetic resonance imaging.Quantitative imaging in medicine and surgery · 2022Article
- Application of the Kaiser score by MRI in patients with breast lesions by ultrasound and mammography.Diagnostic and interventional radiology (Ankara, Turkey) · 2022Article
- Evaluation of Ultrasound Elastography Combined With Chi-Square Automatic Interactive Detector in Reducing Unnecessary Fine-Needle Aspiration on TIRADS 4 Thyroid Nodules.Frontiers in oncology · 2022Article
- Evaluation of the differentiation of benign and malignant breast lesions using synthetic relaxometry and the Kaiser score.Frontiers in oncology · 2022Article
- Magnetic resonance imaging in diagnosis of indeterminate breast (BIRADS 3 & 4A) in a general population.Insights into imaging · 2021Article
- An A.I. classifier derived from 4D radiomics of dynamic contrast-enhanced breast MRI data: potential to avoid unnecessary breast biopsies.European radiology · 2021Article
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Authors and funding
10 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo assess whether using the Tree flowchart obviates unnecessary magnetic resonance imaging (MRI)-guided biopsies in breast lesions only visible on MRI.
methodsThis retrospective IRB-approved study evaluated consecutive suspicious (BI-RADS 4) breast lesions only visible on MRI that were referred to our institution for MRI-guided biopsy. All lesions were evaluated according to the Tree flowchart for breast MRI by experienced readers. The Tree flowchart is a decision rule that assigns levels of suspicion to specific combinations of diagnostic criteria. Receiver operating characteristic (ROC) curve analysis was used to evaluate diagnostic accuracy. To assess reproducibility by kappa statistics, a second reader rated a subset of 82 patients.
resultsThere were 454 patients with 469 histopathologically verified lesions included (98 malignant, 371 benign lesions). The area under the curve (AUC) of the Tree flowchart was 0.873 (95% CI: 0.839-0.901). The inter-reader agreement was almost perfect (kappa: 0.944; 95% CI 0.889-0.998). ROC analysis revealed exclusively benign lesions if the Tree node was ≤2, potentially avoiding unnecessary biopsies in 103 cases (27.8%).
conclusionsUsing the Tree flowchart in breast lesions only visible on MRI, more than 25% of biopsies could be avoided without missing any breast cancer. KEY POINTS: • The Tree flowchart may obviate >25% of unnecessary MRI-guided breast biopsies. • This decrease in MRI-guided biopsies does not cause any false-negative cases. • The Tree flowchart predicts 30.6% of malignancies with >98% specificity. • The Tree's high specificity aids in decision-making after benign biopsy results.
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