{"title":"Development and Validation of a Diagnostic Model for Enhancing Lesions on Breast MRI: Based on Kaiser Score.","authors":"Xi Yi, Guiliang Wang, Yu Yang, Yilei Che","doi":"10.1016/j.acra.2024.09.028","DOIUrl":null,"url":null,"abstract":"<p><strong>Rationale and objectives: </strong>This study aims to develop and validate a new diagnostic model based on the Kaiser score for preoperative diagnosis of the malignancy probability of enhancing lesions on breast MRI.</p><p><strong>Materials and methods: </strong>This study collected consecutive inpatient data (including imaging data, clinical data, and pathological data) from two different institutions. All patients underwent preoperative breast Dynamic Contrast-Enhanced Magnetic Resonance Imaging (DCE-MRI) examinations and were found to have enhancing lesions. These lesions were confirmed as benign or malignant by surgical resection or biopsy pathology (all carcinomas in situ were confirmed by pathology after surgical resection). Data from one institution were used as the training set(284 cases), and data from the other institution were used as the validation set(107 cases). The Kaiser score was directly incorporated into the diagnostic model as a single predictive variable. Other predictive variables were screened using Least Absolute Shrinkage and Selection Operator (LASSO) regression. Multivariate logistic regression was employed to integrate the Kaiser score and other selected predictive variables to construct a new diagnostic model, presented in the form of a nomogram. Receiver operating characteristic (ROC) curve, DeLong test, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were adopted to evaluate and compare the discrimination of the diagnostic model for breast enhancing lesions based on Kaiser score (hereinafter referred to as the \"breast lesion diagnostic model\") and the Kaiser score alone. Calibration curves were used to assess the calibration of the breast lesion diagnostic model, and decision curve analysis (DCA) was used to evaluate the clinical efficacy of the diagnostic model and the Kaiser score.</p><p><strong>Results: </strong>LASSO regression indicated that, besides the indicators already included in the Kaiser score system, \"age\", \"MIP sign\", \"associated imaging features\", and \"clinical breast examination (CBE) results\" were other valuable diagnostic parameters for breast enhancing lesions. In the training set, the AUCs of the breast lesion diagnostic model and the Kaiser score were 0.948 and 0.869, respectively, with a statistically significant difference (p < 0.05). In the validation set, the AUCs of the breast lesion diagnostic model and the Kaiser score were 0.956 and 0.879, respectively, with a statistically significant difference (p < 0.05). The DeLong test, NRI, and IDI showed that the breast lesion diagnostic model had a higher discrimination ability for breast enhancing lesions compared to the Kaiser score alone, with statistically significant differences (p < 0.05). The calibration curves indicated good calibration of the breast lesion diagnostic model. DCA demonstrated that the breast lesion diagnostic model had higher clinical application value, with greater net clinical benefit over a wide range of diagnostic thresholds compared to the Kaiser score.</p><p><strong>Conclusion: </strong>The Kaiser score-based breast lesion diagnostic model, which integrates \"age,\" \"MIP sign\", \"associated imaging features\", and \"CBE results\", can be used for the preoperative diagnosis of the malignancy probability of breast enhancing lesions, and it outperforms the classic Kaiser score in terms of diagnostic performance for such lesions.</p>","PeriodicalId":50928,"journal":{"name":"Academic Radiology","volume":null,"pages":null},"PeriodicalIF":3.8000,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Academic Radiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.acra.2024.09.028","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}
引用次数: 0
Abstract
Rationale and objectives: This study aims to develop and validate a new diagnostic model based on the Kaiser score for preoperative diagnosis of the malignancy probability of enhancing lesions on breast MRI.
Materials and methods: This study collected consecutive inpatient data (including imaging data, clinical data, and pathological data) from two different institutions. All patients underwent preoperative breast Dynamic Contrast-Enhanced Magnetic Resonance Imaging (DCE-MRI) examinations and were found to have enhancing lesions. These lesions were confirmed as benign or malignant by surgical resection or biopsy pathology (all carcinomas in situ were confirmed by pathology after surgical resection). Data from one institution were used as the training set(284 cases), and data from the other institution were used as the validation set(107 cases). The Kaiser score was directly incorporated into the diagnostic model as a single predictive variable. Other predictive variables were screened using Least Absolute Shrinkage and Selection Operator (LASSO) regression. Multivariate logistic regression was employed to integrate the Kaiser score and other selected predictive variables to construct a new diagnostic model, presented in the form of a nomogram. Receiver operating characteristic (ROC) curve, DeLong test, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were adopted to evaluate and compare the discrimination of the diagnostic model for breast enhancing lesions based on Kaiser score (hereinafter referred to as the "breast lesion diagnostic model") and the Kaiser score alone. Calibration curves were used to assess the calibration of the breast lesion diagnostic model, and decision curve analysis (DCA) was used to evaluate the clinical efficacy of the diagnostic model and the Kaiser score.
Results: LASSO regression indicated that, besides the indicators already included in the Kaiser score system, "age", "MIP sign", "associated imaging features", and "clinical breast examination (CBE) results" were other valuable diagnostic parameters for breast enhancing lesions. In the training set, the AUCs of the breast lesion diagnostic model and the Kaiser score were 0.948 and 0.869, respectively, with a statistically significant difference (p < 0.05). In the validation set, the AUCs of the breast lesion diagnostic model and the Kaiser score were 0.956 and 0.879, respectively, with a statistically significant difference (p < 0.05). The DeLong test, NRI, and IDI showed that the breast lesion diagnostic model had a higher discrimination ability for breast enhancing lesions compared to the Kaiser score alone, with statistically significant differences (p < 0.05). The calibration curves indicated good calibration of the breast lesion diagnostic model. DCA demonstrated that the breast lesion diagnostic model had higher clinical application value, with greater net clinical benefit over a wide range of diagnostic thresholds compared to the Kaiser score.
Conclusion: The Kaiser score-based breast lesion diagnostic model, which integrates "age," "MIP sign", "associated imaging features", and "CBE results", can be used for the preoperative diagnosis of the malignancy probability of breast enhancing lesions, and it outperforms the classic Kaiser score in terms of diagnostic performance for such lesions.
理论依据和目标:本研究旨在开发并验证一种基于凯撒评分的新诊断模型,用于术前诊断乳腺 MRI 增强病灶的恶性概率:本研究收集了来自两家不同机构的连续住院患者数据(包括成像数据、临床数据和病理数据)。所有患者在术前都接受了乳腺动态对比增强磁共振成像(DCE-MRI)检查,并发现了增强病灶。这些病灶经手术切除或活检病理证实为良性或恶性(所有原位癌均在手术切除后经病理证实)。一家机构的数据被用作训练集(284 例),另一家机构的数据被用作验证集(107 例)。Kaiser 评分作为单一预测变量被直接纳入诊断模型。其他预测变量采用最小绝对收缩和选择操作器(LASSO)回归法进行筛选。多变量逻辑回归用于整合 Kaiser 评分和其他选定的预测变量,以构建新的诊断模型,并以提名图的形式呈现。采用接收者操作特征曲线(ROC)、DeLong 检验、净再分类改进(NRI)和综合判别改进(IDI)来评估和比较基于 Kaiser 评分的乳腺增强病变诊断模型(以下简称 "乳腺病变诊断模型")和单独使用 Kaiser 评分的诊断模型的判别能力。校准曲线用于评估乳腺病变诊断模型的校准,决策曲线分析(DCA)用于评估诊断模型和 Kaiser 评分的临床疗效:LASSO回归结果表明,除了Kaiser评分系统中已包含的指标外,"年龄"、"MIP标志"、"相关影像学特征 "和 "临床乳腺检查(CBE)结果 "也是对乳腺增强病变有价值的诊断参数。在训练集中,乳腺病变诊断模型和 Kaiser 评分的 AUC 分别为 0.948 和 0.869,差异有统计学意义(p 结论:乳腺病变诊断模型和 Kaiser 评分的 AUC 差异不大:基于 Kaiser 评分的乳腺病变诊断模型综合了 "年龄"、"MIP 标志"、"相关影像学特征 "和 "CBE 结果",可用于乳腺增强病变恶性概率的术前诊断,其诊断效果优于经典的 Kaiser 评分。
期刊介绍:
Academic Radiology publishes original reports of clinical and laboratory investigations in diagnostic imaging, the diagnostic use of radioactive isotopes, computed tomography, positron emission tomography, magnetic resonance imaging, ultrasound, digital subtraction angiography, image-guided interventions and related techniques. It also includes brief technical reports describing original observations, techniques, and instrumental developments; state-of-the-art reports on clinical issues, new technology and other topics of current medical importance; meta-analyses; scientific studies and opinions on radiologic education; and letters to the Editor.