Kaiser score outperforms ADC for BI-RADS 4 breast lesions, with distinct misclassification pitfalls

For BI-RADS 4 breast lesions, Kaiser score AUC 0.901 (95% CI 0.856-0.941) outperformed ADC alone (AUC 0.733) and combination (0.890). ADC had high false-positive rate (66.1%) in benign cellular lesions. DCIS and mucinous carcinoma were often false negatives.

• Retrospective study of 222 patients with BI-RADS 4 lesions. Kaiser score AUC 0.901, ADC AUC 0.733, combination AUC 0.890 (p<0.001 for Kaiser vs ADC).
• Kaiser performed better in mass lesions (AUC 0.926) than non-mass enhancement (AUC 0.801).
• False positives: ADC 66.1% vs Kaiser 19.8% in benign lesions (fibroadenoma, hyperplasia, papilloma). False negatives: DCIS and mucinous carcinoma most common.

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