Diagnostic performance of the Kaiser score compared with BI-RADS in breast lesion characterization on contrast-enhanced spectral mammography

Abstract Purpose The aim of this study was to evaluate the diagnostic performance of the Kaiser Score (KS) compared with BI-RADS in the characterization of breast lesions detected on contrast-enhanced spectral mammography (CESM), using histopathology as the reference standard. Materials and methods This prospective single-center study included 36 patients with 36 enhancing breast lesions detected on CESM between February 2024 and February 2025. Each lesion was independently evaluated using both BI-RADS descriptors and the Kaiser Score algorithm. Histopathological results obtained by ultrasound-guided core needle biopsy served as the reference standard. Diagnostic performance parameters including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated. Receiver operating characteristic (ROC) curve analysis was performed to assess the diagnostic performance of both scoring systems. Results There was a perfect agreement between KS and BI-RADS in malignant lesion characterization (kappa coefficient = 0.89) and a fair agreement between KS and BI-RADS in benign lesion characterization (kappa coefficient = 0.31). The area under the curve (AUC) for the Kaiser Score was 0.996, compared with 0.87 for BI-RADS, indicating improved diagnostic performance. The implementation of KS-enhanced CESM possessed the potential to preclude approximately 27.7% of nonessential biopsy procedures. Conclusion Kaiser Score demonstrated superior overall accuracy than BI-RADS in characterization of breast lesions. Kaiser Score provides significant added diagnostic value over BI-RADS in improving sensitivity and overall diagnostic accuracy in breast lesion characterization using contrast-enhanced spectral mammography.