DIAGNOSTIC ACCURACY OF TYPE II KUHL, CURVE BREAST MRI IN DIFFERENTIATING BENIGN FROM MALIGNANT LESION KEEPING HISTOPATHOLOGY AS GOLD STANDARD

Abstract

Background: Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is a sensitive tool for breast cancer detection, with kinetic curve analysis (Kuhl classification) being a key component. However, the diagnostic value of the Type II (plateau) curve is challenging due to its significant overlap in appearance between benign and malignant lesions. Objective: To evaluate the diagnostic accuracy of the Type II (plateau) kinetic curve on breast MRI in differentiating benign from malignant breast lesions, using histopathology as the gold standard. Methods: This prospective, cross-sectional study was conducted over six months and included 150 women with breast lesions categorized as BI-RADS 4 or 5 on prior imaging. All participants underwent DCE-MRI, and kinetic curves were analyzed by two blinded radiologists. Histopathological results from core needle biopsy or surgical excision served as the reference standard. Diagnostic metrics (sensitivity, specificity, predictive values, accuracy) for Type II curves were calculated. Results: Out of 150 lesions, 92 (61.3%) were malignant and 58 (38.7%) were benign on histopathology. Among the 50 lesions with a Type II curve, 38 were malignant and 12 were benign. The diagnostic performance of the Type II curve for predicting malignancy showed a sensitivity of 41.3%, specificity of 79.3%, positive predictive value (PPV) of 76.0%, negative predictive value (NPV) of 46.0%, and an overall diagnostic accuracy of 56.0%. Conclusion: The Type II (plateau) kinetic curve demonstrates moderate specificity and PPV but low sensitivity and NPV for identifying malignant breast lesions. Its substantial overlap between benign and malignant entities limits its reliability as a standalone diagnostic tool. Therefore, kinetic analysis must be integrated with morphological BI-RADS descriptors to improve diagnostic accuracy and guide clinical decision-making.