ArticleFrontiers in oncology2026
Diagnostic performance of Kaiser score, ADC, and their combination for BI-RADS 4 breast lesions: subgroup and misclassification analysis.
Article in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The Kaiser score and apparent diffusion coefficient (ADC) have been proposed as diagnostic adjuncts to reduce unnecessary biopsies in Breast Imaging Reporting and Data System (BI-RADS) 4 breast lesions. However, which specific histopathologic entities are prone to misclassification by each diagnostic model remains poorly characterized, limiting clinical guidance for borderline cases. Objective: To compare the diagnostic performance of the Kaiser score, ADC, and their combination (Kaiser+) stratified by lesion morphology, and to identify histopathologic subtypes most susceptible to misclassification. Methods: This retrospective study included 222 patients with BI-RADS 4 breast lesions confirmed by histopathology. Two radiologists independently evaluated lesions using the Kaiser score and ADC values (threshold: 1.4 × 10 Results: The Kaiser score achieved the highest area under the curve (AUC) of 0.901 (95% CI: 0.856-0.941), followed by Kaiser+ (AUC 0.890; 95% CI: 0.845-0.930) and ADC alone (AUC 0.733; 95% CI: 0.666-0.800; Conclusion: The Kaiser score outperformed ADC alone in BI-RADS 4 lesions. Pathology-stratified analysis identified subtype-specific diagnostic pitfalls: benign cellular and proliferative lesions drive FP cases (especially with ADC), while low-conspicuity malignancies (DCIS, mucinous carcinoma) drive FN cases. Awareness of these patterns may guide individualized biopsy decisions in clinical practice.
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