2004 CHARACTERIZATION OF COMPLEX RENAL CYSTS: A CRITICAL EVALUATION OF THE BOSNIAK CLASSIFICATION

Abstract

You have accessJournal of UrologyImaging/Radiology: Uroradiology I1 Apr 20102004 CHARACTERIZATION OF COMPLEX RENAL CYSTS: A CRITICAL EVALUATION OF THE BOSNIAK CLASSIFICATION Ole Graumann, Susanne Osther, and Palle Osther Ole GraumannOle Graumann More articles by this author , Susanne OstherSusanne Osther More articles by this author , and Palle OstherPalle Osther More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2037AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Complex renal cysts represent a major clinical problem, since it is often difficult to exclude malignancy. The Bosniak Classification system - based on Computed Tomography (CT) – is widely used to categorize cystic renal lesions. Bosniak category I and II lesions are predicted to be benign, category III potential malignant and IV predominantly malignant. Category IIF has subsequently been introduced for those cysts that cannot be clearly categorized as category II or III and therefore need CT follow-up. The aim of the present study was to critically evaluate available data on the Bosniak Classification. METHODS We reviewed all publications found in an Entrez Pubmed search at the end of October 2009. Only English publications were included. We focused on clinical applicability and the use of other imaging modalities than CT to categorize complex renal cysts. RESULTS Nine retrospective studies were found. Most series were small (< 30 patients). Only tree studies comprised more than 30 patients. When the results of these 3 studies were pooled the percentage of malignancy was: Category I: 0 % (0/48), Category II: 20 % (2/10), Category III: 63 % (44/70) and Category IV: 95 % (56/59). In only one study category IIF was included. However, in this study 95% of category II lesions could avoid surgical intervention due to non-progression over time. Few studies have focused on the use of magnetic resonance imaging (MRI) and contrast enhanced ultrasonography (CEUS). Both modalities seem to have reasonable agreement with CT, although both MRI and CEUS had a tendency to upgrade lesions from category III to IV. CONCLUSIONS The main problem of the Bosniak classification is to separate category II and III lesions, which is of major importance, since decision of intervention is based on this separation. The use of category IIF seems promising in order to detect those category II lesions that eventually will develop into malignancy and reduce over-treatment of lesions originally classified as category III. The scientific basis of this “new” classification strategy is, however, still missing, and we urge centers using the Bosniak classification to prospectively register their data. Data on other imaging modalities are still too limited for conclusions, but in order to reduce the ionic radiation of CT in this group of patients, prospective studies on the use of MRI and CEUS should be conducted. Fredericia, Denmark© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e777 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ole Graumann More articles by this author Susanne Osther More articles by this author Palle Osther More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...