Kaiser评分不同界值应用于乳腺病变MRI诊断的效能比较  

Efficacy of different cut-off values of Kaiser score in MRI diagnosis of breast lesions

作　　者：易熙 王贵良[1] 马荣 曾禹莉[1] 陈鹰 樊志红[1] YI Xi;WANG Guiliang;MA Rong;ZENG Yuli;CHEN Ying;FAN Zhihong(Second Department of Radiology,Hunan Provincial People's Hospital(The First-affiliated Hospital of Hunan Normal University),Changsha 410016,China)

机构地区：[1]湖南省人民医院(湖南师范大学附属第一医院)放射二科,湖南长沙410016

出　　处：《分子影像学杂志》2021年第6期911-916,共6页Journal of Molecular Imaging

基　　金：湖南省卫生健康委科研计划基金(20201448)。

摘　　要：目的研究诊断决策支持工具Kaiser评分系统中不同评分界值应用于乳腺病变MRI诊断中的效能,探索良恶性病变最佳参考评分界值从而避免过度的乳腺活检,并与传统的BI-RADS分类诊断标准进行诊断效能的比较。方法回顾并分析来自92例患者共101个术前行乳腺1.5 T MRI检查并被手术或穿刺病理证实的病灶的临床资料,由2位中级职称的影像科医生对所有病例独立根据Kaiser评分系统给出评分,探讨Kaiser评分系统应用于乳腺病变MRI中的诊断效能并与传统的BI-RADS分类诊断进行诊断效能比较,统计Kaiser评分在不同临界值下的敏感度、特异性和似然比,并分析2位阅片者之间的Kaiser评分一致性。结果92例患者共101个病灶,病理证实其中恶性病灶34个(33.66%),良性病灶67个(66.34%);应用Kaiser评分系统的曲线下面积值为0.969,BI-RADS分类的曲线下面积值为0.702,两种诊断方法的诊断效能差异有统计学意义(P<0.01),分别使用临界值≥4、≥5、≥6做为良恶性病变的分界值,可以准确识别100.00%、100.00%、91.98%的恶性病变,特异度分别为79.10%、80.60%、88.06%,以高截断值≥7分作为判断良恶性病变的参考界值,可以正确识别79.41%的恶性病变,特异性为98.51%,阳性似然比为53.21。2位阅片者之间的Kaiser评分一致性良好(Kappa值=0.89,P<0.01)。结论在乳腺病变MRI诊断中应用Kaiser评分对提高诊断准确性有益,同时以≥5为判断良恶性病变的诊断界值,可以获得最佳的综合诊断效能,针对特定诊断目标,在Kaiser评分中合理运用高诊断界值,可最大程度地避免过度乳腺活检。Objective To explore the efficacy of different cut-off values in Kaiser scoring system as diagnostic decision support tool in MRI diagnosis of breast lesions,and explore the best reference cut-off value of benign and malignant lesions so as to avoid excessive breast biopsy,and compare the diagnostic efficiency with the traditional BI-RADS classification diagnostic criteria.Methods The imaging data of 101 breast lesions from 92 patients examined by 1.5 T MRI before operation and confirmed by operation or puncture pathology were reviewed and analyzed.Two intermediate radiologist independently scored all cases according to Kaiser score system,to explore the diagnostic efficacy of Kaiser score system in MRI of breast lesions and compare it with traditional BI-RADS classification diagnosis.The sensitivity,specificity and likelihood ratio of Kaiser score under different critical values were calculated,and the consistency of Kaiser score between the two readers was analyzed.Results There were 101 lesions from 92 patients,including 34 malignant lesions(33.66%)and 67 benign lesions(66.34%).The AUC value of Kaiser score system was 0.969 and that of BI-RADS classification was 0.702.There was a significant difference between two diagnostic methods(P<0.01).Using the critical value≥4,≥5 and≥6 as the cut-off value of benign and malignant lesions,we could accurately identify 100.00%,100.00%and 91.98%malignant lesions,and the specificity is 79.10%,80.60%and 88.06%.Taking the high cut-off value of 7 as the reference cut-off value for judging benign and malignant lesions,we could correctly identify 79.41%of malignant lesions,with a specificity of 98.51%and a positive likelihood ratio of 53.21.The Kaiser scores of the two readers were consistent(Kappa=0.89,P<0.01).Conclusion The application of Kaiser score in MRI diagnosis of breast lesions is beneficial to improve the diagnostic accuracy,taking≥5 as the diagnostic threshold for judging benign and malignant lesions.The best comprehensive diagnostic efficiency could be obtain

关 键 词：磁共振成像 乳腺恶性病变 Kaiser评分 BI-RADS 

分 类 号：R655.8[医药卫生—外科学] R737.9[医药卫生—临床医学]