Bosniak Renal Cyst Classification Research Articles

Automatic kidney segmentation using 2.5D ResUNet and 2.5D DenseUNet for malignant potential analysis in complex renal cyst based on CT images

Bosniak renal cyst classification has been widely used in determining the complexity of a renal cyst. However, it turns out that about half of patients undergoing surgery for Bosniak category III, take surgical risks that reward them with no clinical benefit at all. This is because their pathological results reveal that the cysts are actually benign not malignant. This problem inspires us to use recently popular deep learning techniques and study alternative analytics methods for precise binary classification (benign or malignant tumor) on Computerized Tomography (CT) images. To achieve our goal, two consecutive steps are required–segmenting kidney organs or lesions from CT images then classifying the segmented kidneys. In this paper, we propose a study of kidney segmentation using 2.5D ResUNet and 2.5D DenseUNet for efficiently extracting intra-slice and inter-slice features. Our models are trained and validated on the public data set from Kidney Tumor Segmentation (KiTS19) challenge in two different training environments. As a result, all experimental models achieve high mean kidney Dice scores of at least 95% on the KiTS19 validation set consisting of 60 patients. Apart from the KiTS19 data set, we also conduct separate experiments on abdomen CT images of four Thai patients. Based on the four Thai patients, our experimental models show a drop in performance, where the best mean kidney Dice score is 87.60%.

EFSUMB 2020 Proposal for a Contrast-Enhanced Ultrasound-Adapted Bosniak Cyst Categorization - Position Statement.

The well-established Bosniak renal cyst classification is based on contrast-enhanced computed tomography determining the malignant potential of cystic renal lesions. Ultrasound has not been incorporated into this pathway. However, the development of ultrasound contrast agents coupled with the superior resolution of ultrasound makes it possible to redefine the imaging of cystic renal lesions. In this position statement, an EFSUMB Expert Task Force reviews, analyzes, and describes the accumulated knowledge and limitations and presents the current position on the use of ultrasound contrast agents in the evaluation of cystic renal lesions.

PD4-07 CLINICAL OUTCOMES OF BOSNIAK IIF CYSTIC RENAL LESIONS: A 5-YEAR RETROSPECTIVE STUDY

You have accessJournal of UrologyImaging/Radiology I1 Apr 2014PD4-07 CLINICAL OUTCOMES OF BOSNIAK IIF CYSTIC RENAL LESIONS: A 5-YEAR RETROSPECTIVE STUDY Krystal Leong, Jeanne Darbinian, and Jay Belani Krystal LeongKrystal Leong More articles by this author , Jeanne DarbinianJeanne Darbinian More articles by this author , and Jay BelaniJay Belani More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.228AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The Bosniak renal cyst classification system is used to stratify renal cysts into their risk of malignancy. Bosniak I and II cysts are considered benign. Bosniak III and IV cysts are considered to have a high malignant potential. A Bosniak IIF renal cyst cannot clearly be categorized and needs follow-up imaging, but current literature offers scant data on the natural course of a IIF cyst, and there is no clear guideline on how best to follow these lesions. The objective of our study is to assess the radiologic progression and 5-year outcomes of Bosniak IIF renal lesions. METHODS We retrospectively identified 860 patients from January 1, 2005 through December 31, 2007 who had a possible complex renal cyst on computed tomography scan (CT), magnetic resonance imaging (MRI), or ultrasound (US). All reports which contained the words “Bosniak” or “complex” and “renal cyst” were included in the study population. Cysts were verified by CT or MRI if initial imaging was an ultrasound. Patients were included in the study cohort if they were confirmed to have a Bosniak IIF cyst and had at least 5 years of follow-up data. Of the 860 eligible patients, 112 met the inclusion criteria. Over a 5 year period, each patient was evaluated for transformation, defined as progression of Bosniak category on follow-up imaging, surgical or percutaneous treatment of the lesion, or pathologic diagnosis of renal cell carcinoma (RCC). RESULTS At 5 years, 8 of the 112 (7.1%) Bosniak IIF renal cysts underwent transformation. Of these, 3 were upgraded to Bosniak III, 1 had a complete nephrectomy at year 3, and 1 had a partial nephrectomy at year 4, both of which had benign pathology. 3 patients had surgical intervention within 8 months of follow-up and were found to have RCC. 29 of the 112 (25.9%) cysts were downgraded at some point during the five years. No patient died of RCC or developed metastatic RCC. CONCLUSIONS This is the largest cohort of Bosniak IIF renal cysts with the longest term of follow-up in the literature to date. Our data suggests that the vast majority of IIF lesions behave benignly, and the highest risk of malignant transformation is within a year of initial diagnosis. There were no patients with local invasion, metastatic spread, or death from RCC at five years of follow-up. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e53 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Krystal Leong More articles by this author Jeanne Darbinian More articles by this author Jay Belani More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Bosniak renal cyst classification : 12 years experience of a single center

Objective To evaluate the clinical value of Bosniak renal cyst classification in the treatment of renal cyst disease.Methods The data of 509 patients,diagnosed with renal cystic disease from 2001 to 2012 in our institution,were retrospectively reviewed.Of those patients,there were 304 males and 205 females.The average age was 54 years (range 15-82 years).The average diameter of renal cysts was 6.8 cm (range,1.0-16.0 cm).According to Bosniak classification,there were 371 cases of category Ⅰ,60 cases of category Ⅱ,23 cases of category Ⅱ F,41 cases of category Ⅲ and 14 cases of category Ⅳ.Laparoscopic decortication of renal cysts was performed in 439 cases.Nephron sparing surgery was performed in 45 cases,including laparoscopic procedure in 20 cases.Radical nephrectomy was performed in 25 cases,including laparoscopic procedure in 5 cases.Results Benign lesions were diagnosed in 470 cases,including simple renal cyst in 448 cases,multilocular renal cyst in 15 cases,cystic nephroma in 3 cases,old hematoma in 2 cases,teratoma in 1 case and angiomyolipoma in 1 case.Malignant tumors were diagnosed in 39 cases,including clear cell carcinoma in 20 cases,multilocular renal cell carcinoma in 18 cases,and papillary renal cell carcinoma in 1 case.Based on Fuhrman nuclear grade classification,there were 28 cases (72％) of grade Ⅰ,9 cases (23％) of grade Ⅱ,2 cases (5％) of grade Ⅲ.In pathologic stage,T1 was diagnosed in 36 cases (92％),T2 was diagnosed in 3 cases (8％).The malignant rate was 1％ in Bosniak category Ⅰ (3/371),3％ in category Ⅱ (2/60),17％ in category ⅡF(4/23),44％ in category Ⅲ (18/41),and 86％ in category Ⅳ (12/14).Thirty-seven cases of malignancy were followed up for 3-144 months (median 53 months).All cases survived without recurrence or metastasis.Conclusions The Bosniak classification is helpful for diagnosis and management of renal cystic disease.There is a low malignant rate in category Ⅰ and Ⅱ cysts,but category Ⅲ and Ⅳ usually require surgical removal due to their high malignant rate.It should make effort to undertake laparoscopy and nephron-sparing surgery if technically feasible. Key words: Kidney diseases, cystic ; Bosniak classification ; Laparoscopes ; Nephron-sparing surgery

Reassessment of the treatment of Bosniak category II-m renal cyst

Objective To reassess the treatment of Bosniak category Ⅱ-Ⅲ renal cyst.Methods Sixty-eight cases of Bosniak category Ⅱ-Ⅲ renal cyst were operated from 2005 to 2008 in our institute.The average patient age was 40 years with the average renal cyst diameter of 5.1 cm.There were 37 left lesions and 31 right lesions with 31 cases of category Ⅱ (including 13 cases of category Ⅱ F) and 37 cases of category Ⅲ.Renal unroofing were performed in 49 cases with 9 cases found malignant and followed by radical nephrectomy,19 cases were diagnosed as malignancy preoperatively and nephron sparing surgery or radical nephrectomy were performed in these cases.Results Malignant lesions were found in 21 cases and benign lesions were found in 47 cases.The malignant rate was 9.7％ in category Ⅱ (15.4％ in category Ⅱ F),48.6％ in category Ⅲ.Nine cases were diagnosed benign preoperatively but confirmed malignancy after operation; 7 cases were diagnosed malignancy preoperatively but confirmed benign after operation.Forty-two cases were followed up for 8-65 months with 15 cases of malignancy and 27 cases of benign lesions.The recurrence of renal cyst occurred in 6 cases of benign lesions and recurrence and metastasis occurred in 3 cases of malignancy in 1-5 years.Conclusions It is difficult to draw a therapeutic principle for Bosniak category Ⅱ-Ⅲ renal cyst because of the uncertainty of the lesion.Partial nephrectomy or renal cystectomy is a good choice in the treatment of Bosniak category Ⅱ-Ⅲ renal cysts. Key words: Renal cyst; Bosniak renal cyst classification; Malignant tumor

The Bosniak Renal Cyst Classification: 25 Years Later

In the past 25 years, there have been continuous advances in the diagnosis of disease throughout the body owing to the introduction of new technology and the experience gained with its use. However, the imaging and evaluation of complicated cystic lesions of the kidneys frequently remains a difficult problem. The classification of renal cystic lesions suggested 25 years ago, now referred to as the Bosniak renal cyst classification, remains pertinent to the diagnosis and management of these difficult-to-diagnose complicated cystic masses.

Differential Diagnosis of Complex Renal Cysts Based on Lesion Size along with the Bosniak Renal Cyst Classification

PurposeTo identify size criteria for complex cystic renal masses that can distinguish renal cell carcinoma from benign cysts supplementing the Bosniak classification.Materials and MethodsWe reviewed the records of 97 patients who underwent surgery for complex cystic renal masses from January 2001 to April 2010. The pathological results were compared with the lesion sizes measured by preoperative computed tomography and other radiological features (contrast enhancement, irregularities of cyst walls and septa, and calcification) were also obtained for categorization according to the Bosniak renal cyst classification.ResultsMalignancy was significantly associated with cyst size (>2 cm), male gender, and younger patient age (<50 years). According to the Bosniak classification, there was no category I cyst, and all 8 category II cysts were benign. However, 3 of 18 (17%) category IIF cysts, 21 of 39 (54%) category III cysts, and 29 of 32 (90%) category IV cysts were malignant. All category IIF cysts were benign in patients older than 50 years of age.ConclusionMany complex cystic renal masses smaller than 2 cm were benign. We suggest that lesion size should be taken into account when formulating treatment plans for complex cystic renal masses.

Category Migration of Renal Cystic Masses with Use of Gadolinium-Enhanced Magnetic Resonance Imaging

The Bosniak renal cyst classification has been accepted by urologists and radiologists as a way of diagnosing cystic renal masses and determining the management approach. We report two cases of a renal cystic mass that showed a category change from category II on the basis of enhanced computed tomography to category IV after further gadolinium-enhanced magnetic resonance imaging. In both cases, the cysts were later confirmed as kidney cancer by pathology.

Bosniak Category IIF Designation and Surgery for Complex Renal Cysts

We investigated whether adding the IIF categorization improved the accuracy of Bosniak renal cyst classification, as evidenced by a low rate of progression in IIF lesions and a high rate of malignancy in category III lesions. We retrospectively reviewed the records of patients with complex renal cysts categorized as a Bosniak IIF or III. Surveillance imaging and pathological outcomes of category IIF cysts were recorded to determine radiological predictors of progression. Pathological outcomes of category III cysts were recorded to determine the malignancy rate. A total of 112 patients met study inclusion criteria, of whom 81 were initially diagnosed with a category IIF cyst and 31 had a Bosniak category III cyst. At a median followup of 15 months 14.8% of Bosniak IIF lesions progressed in complexity with a median time to progression of 11 months (maximum greater than 4 years). There were no differences in tumor or patient characteristics between cysts that progressed and those that remained stable. In the 33 patients with Bosniak III lesions who underwent surgical extirpation the malignancy rate was 81.8%. Most patients had low stage, low grade disease and remained recurrence-free at a median followup of 6 months. Adding the IIF category has increased the accuracy and clinical impact of the Bosniak categorization system, as evidenced by a low rate of progression in category IIF cysts and an increased rate of malignancy in surgically treated category III lesions compared to those in historical controls.

Laparoscopic Deroofing of a Renal Cyst

Cysts of the kidney usually originate from the renal parenchyma after tubule obstruction; rarely pyelocalyceal cysts occur, originating from transitional urothelium. Neoplasia is a rare but possible complication. A 45-year-old man was found to have a cyst related to the right kidney. Computed tomography demonstrated minimal calcification in the wall (Bosniak II). Symptom-relieving percutaneous drainage yielded clear fluid; resultant cytology was negative. After rapid reaccumulation, laparoscopic deroofing was performed. No communication within the renal pelvis was detected however histology revealed transitional cell carcinoma. An open radical nephroureterectomy was performed; adjuvant chemotherapy was given. Three previous cases of malignancy in a pyelocalyceal cyst have been reported. This is the first reported after laparoscopic deroofing of a cyst. Despite widespread use of the Bosniak renal cyst classification, the management of category II cysts remains contentious. This case should serve as a warning to clinicians that seemingly benign cysts of the kidney may harbor underlying neoplasia. Intraoperative frozen section should be considered in all cases where preoperative imaging suggests Bosniak II classification.

An update of the Bosniak renal cyst classification system

w m s [ i s m t n he Bosniak renal cyst classification was first introduced in 19861 and has been accepted by rologists and radiologists as a way of diagnosing, iscussing, and determining the management aproach to cystic renal masses.2–4 Using the lesion’s orphology and enhancement characteristics, ach lesion can be categorized into one of five roups (categories I, II, IIF, III, and IV; Table I), ith associated recommendations for patient treatent. With additional experience during the past wo decades, the Bosniak renal cyst classification as been updated and refined.5,6 However, pubished reports have incorrectly described and aplied the classification system,7–10 leading to conusion in its use that could be detrimental to atient care. Therefore, the purpose of this comentary is to present an up-to-date version of the osniak renal cyst classification, point out potenial errors in its use, and present our approach to he evaluation of cystic lesions of the kidney. We elieve that this is particularly relevant in this age f laparoscopic surgery and ablative techniques. ecause these procedures are less invasive, there ay be a tendency to treat patients using these techiques on the basis of imaging studies that are not echnically adequate or have been interpreted incorectly. High-quality imaging studies are needed for ccurate characterization of renal masses to avoid unecessary surgery, even if it is minimally invasive. One of the major changes in the original classifiation was the introduction of category IIF (F for ollow-up), which was added to include cystic leions that are slightly more complex than category I, but not complex enough to fulfill the criteria for ategory III.6,11–13 This category was introduced on he basis of experience gained after the removal of enign category III cysts. Category IIF lesions are