Complex Renal Cysts Research Articles

Laparoscopic nephron-sparing surgery for complex renal cystic lesions: a single-center experience.

This study aimed to explore the feasibility and safety of laparoscopic nephron-sparing surgery (LNSS) for complex renal cystic lesions. A retrospective study was conducted on 83 cases of complex renal cystic lesions treated with LNSS in our hospital. There were 32 men and 51 women, ranging in age from 24 to 73years (average, 47.22±9.03years). The diameter of the cysts was 1.5-5.9cm (average, 3.44±0.86cm). According to the Bosniak classification, there were 15 cases of type II, 23 cases of type IIF, 29 cases of type III, and 16 cases of type IV complex renal cystic lesions. According to clinical classification based on the difficulty of laparoscopic partial nephrectomy and the depth of the lesion, the 83 complex renal cystic lesions were divided into 48 cases of the extra-renal type, 15 cases of the centrally located type, seven cases of the renal sinus type, and 13 cases of the renal hilum type. Laparoscopic partial nephrectomy was successful in all 83 patients. The surgical time was 35-102min (average, 52.13±14.38min), the intraoperative bleeding volume was 10-200ml (average, 27.25±12.26ml), and the renal artery occlusion time was 12-28min (average, 12.46±4.45min). There was no significant change in creatinine before and after surgery. The postoperative pathological results showed 71 cases of renal clear cell carcinoma, five cases of low malignant potential multilocular cystic renal tumors, and seven cases of pure renal cysts with all margins negative. There is potential for the malignant transformation of complex renal cysts into renal cell carcinoma. For complex renal cysts classified as Bosniak IIF or higher, surgical intervention is recommended, and LNSS is safe and effective. The complexity of the surgical procedure varies depending on the location classification of the complex renal cysts.

Clinicopathological characteristics and typing of multilocular cystic renal neoplasm of low malignant potential.

Up until now, no research has been reported on the association between the clinical growth rate of multilocular cystic renal neoplasm of low malignant potential (MCRNLMP) and computed tomography (CT) imaging characteristics. Our study sought to examine the correlation between them, with the objective of distinguishing unique features of MCRNLMP from renal cysts and exploring effective management strategies. To investigate optimal management strategies of MCRNLMP. We retrospectively collected and analyzed data from 1520 patients, comprising 1444 with renal cysts and 76 with MCRNLMP, who underwent renal cyst decompression, radical nephrectomy, or nephron-sparing surgery for renal cystic disease between January 2013 and December 2021 at our institution. Detection of MCRNLMP utilized the Bosniak classification for imaging and the 2016 World Health Organization criteria for clinical pathology. Our meticulous exploration has revealed compelling findings on the occurrence of MCRNLMP. Precisely, it comprises 1.48% of all cases involving simple renal cysts, 5.26% of those with complex renal cysts, and a noteworthy 12.11% of renal tumors coexisting with renal cysts, indicating a statistically significant difference (P = 0.001). Moreover, MCRNLMP constituted a significant 22.37% of the patient population whose cysts demonstrated a rapid growth rate of ≥ 2.0 cm/year, whereas it only represented 0.66% among those with a growth rate below 2.0 cm/year. Of the 76 MCRNLMP cases studied, none of the nine patients who underwent subsequent nephron-sparing surgery or radical nephrectomy following renal cyst decompression experienced recurrence or metastasis. In the remaining 67 patients, who were actively monitored over a 3-year postoperative period, only one showed suspicious recurrence on CT scans. MCRNLMP can be tentatively identified and categorized into three types based on CT scanning and growth rate indicators. In treating MCRNLMP, partial nephrectomy is preferred, while radical nephrectomy should be minimized. After surgery, active monitoring is advisable to prevent unnecessary nephrectomy.

Bilateral renal lymphangiectasia: a rare renal cystic disease managed by minimal invasive approach—a case report

BackgroundRenal cystic diseases are one of the commonest renal lesions encountered in clinical practice. Although common, most of the cysts are solitary, benign, asymptomatic and seldom clinically significant. But, renal lymphangiectasia is an exception. These are rare lymphatic malformation seen around the kidneys and in the retroperitoneum. It masquerades clinically like ADPKD and renal tumors and radiologically like a complex renal cyst. Although the cyst is benign, it possesses a significant impact on the quality of life. Because of its rarity, the management of this condition has not been well defined in the literature. A clinician must be aware of this rare condition and able to differentiate it from other similar conditions to aid in appropriate management. Hence, we present a case report of a female with bilateral renal lymphangiectasia managed successfully by laparoscopic excision.Case presentationA 34-year-old hypertensive female came with complaints of bilaterally progressive flank masses for 3 months and breathlessness for 2 weeks. On examination, she had bilateral pitting pedal edema, bilateral palpable renal mass and ascites. She had nephrotic range proteinuria, hypoalbuminemia and normal renal function. Imaging showed 22-cm bilateral peri-renal and hilar multi-loculated cystic lesions, suggestive of bilateral renal lymphangiectasia. Antihypertensives and percutaneous interventions were not successful in relieving her symptoms. Subsequently, she was managed with laparoscopic excision on both sides. After surgery, she had an uneventful postoperative period and good symptomatic relief. No recurrence of the lesion found in follow-up CT imaging after 18 months.ConclusionsRenal lymphangiectasia is a rare yet clinically significant cystic lesion of the kidney. It can be diagnosed confidently by noninvasive imaging modalities. Medical treatment offered for mild symptomatic disease. Patients with severe symptoms need surgical intervention especially if it is not responding to medical management. Minimal invasive approach is feasible and successful in the management of this voluminous disease.

Three Dimensional (3D) Laparoscopic Nephron-sparing Treatment of a Huge Cystic Nephroma: A Case Report and Literature Review.

Cystic nephroma (CN) is a very rare, benign, renal cystic lesion, which is characterized by a usually unilateral, multicystic kidney mass. In adults it is seen more frequently in females (1:8 male-to-female ratio). The peak incidence of CN is between 50 and 60 years of age. Median age at diagnosis is 55 years for females and 44 years for men and it is a rare entity in adults under 30 years of age. We report the case of a 52-year-old female patient with chronic right-flank pain, who was treated at our hospital. A multiloculated 10×8.6 cm Bosniak IV renal cyst tumor was depicted on retroperitoneal computed tomography. After a three-dimensional laparoscopic partial nephrectomy, the histopathological specimen examination revealed: a multilocular cystic nephroma. CNs are rare benign tumors that should be included in the differential diagnosis when treating large multiloculated complex renal cysts.

Tuberous Sclerosis Complex (TSC) Renal Cyst Extracellular Vesicles (EVs) Have Unique miRNA and Protein Profile

Tuberous Sclerosis Complex (TSC) Renal Cyst Extracellular Vesicles (EVs) Have Unique miRNA and Protein Profile

Fumarate hydratase-deficient renal cell carcinoma: a case report and review of the literature

BackgroundFumarate hydratase-deficient renal cell carcinoma is a rare pathological subtype that was defined by the World Health Organization (WHO 5th edition) in 2022. At present, only a few hundreds of cases have been reported worldwide, mainly in Europe and the United States. A case of a Chinese patient is reported here, along with a literature review.Case reportA 60-year-old Asian male who complained of hematuria for 20 days was admitted to the hospital. Contrast enhanced Computer Tomography showed that the volume of the right kidney was increased, with a patchy low-density shadow with infiltrative growth inside that had a significantly lower signal intensity than the renal cortex; thus, the possibility of collecting duct carcinoma or lymphoma, was considered. Enlarged perirenal and retroperitoneal lymph nodes were also seen, along with bilateral renal cysts. Eight years prior, ultrasonography had shown a complex renal cyst in the right kidney, and no treatment was administered at that time. Laparoscopic radical nephrectomy of the right kidney was performed this time, and the postoperative specimens were submitted for pathological examination. Because immunohistochemistry showed the loss of fumarate hydratase protein expression and the possibility of fumarate hydratase-deficient renal cell carcinoma was considered, corresponding molecular pathological tests were performed, and the results showed an FHp.R233H (arginine > histidine) germline mutation (inactivation mutation). The postoperative pathological diagnosis was fumarate hydratase-deficient renal cell carcinoma in the right kidney, T3aN1M0. The patient was treated with sunitinib, and bone and liver metastases developed half a year later. The treatment was then changed to axitinib and toripalimab. At present, the patient is in stable condition, and there has been no progression of the metastases.ConclusionFumarate hydratase-deficient renal cell carcinoma is a very rare renal tumor that is defined on a molecular basis. It is highly malignant and metastasizes early. Therefore, fully understanding the disease, enabling detection and diagnosis and administering treatment are particularly important.

The Modified Bosniak Classification for Intermediate and High-Risk Renal Cysts.

Background Renal cysts are uncommon among the pediatric population, and their transformation into malignant lesions is also uncommon. Early detection can prevent further complications and protect renal function. Bosniak classification is a computed tomography-based classification for renal cysts developed for adults. Children are more susceptible to CT radiation. Therefore, a modified Bosniak classification for children based on the ultrasound (US) can be used if it shows reliability and accuracy. Aim To apply the modified Bosniak classification system among children with renal cysts. Methods This was a retrospective study that was conducted on pediatric patients who underwent surgery for intermediate and high-risk complex renal cysts in Prince Sultan Military Medical City, Riyadh, Saudi Arabia using radiological information from 2009 to 2022. The collected data included demographics, medical history, radiological findings, and characteristics of renal cysts. SPSS Statistics v. 22 (IBM Corp., Armonk, NY) was used to analyze the data. Results There were 40 children included in the study based on the US-modified Bosniak classification. Around 26.3% of patientshad class I and 39.5% had class II renal cysts. Histopathology showed that 10% had Wilms tumor, and 15% had benign lesions. There were significant correlations between pathology findings and US findings (p=0.004), and CT findings (p=0.016). Conclusion The modified Bosniak classification based on the US is sensitive, specific, and sufficiently accurate in the classification of renal cysts among children. Also, the size of the renal cysts can be a diagnostic marker of differentiation of benign and malignant cysts with high sensitivity and specificity.

MP64-03 LOW METASTATIC POTENTIAL OF COMPLEX RENAL CYSTS: THE Case FOR ACTIVE SURVEILLANCE

You have accessJournal of UrologyCME1 Apr 2023MP64-03 LOW METASTATIC POTENTIAL OF COMPLEX RENAL CYSTS: THE Case FOR ACTIVE SURVEILLANCE Hannah Thomas, Shideh Abedi, Toronto, Canada, Thenappan Chandrasekar, PA Philadelphia, Kartik Jhaveri, Toronto, Canada, Johan Bjorklund, Stockholm, Sweden, Douglas Cheung, Michael Jewett, and Antonio Finelli Hannah ThomasHannah Thomas More articles by this author , Shideh AbediShideh Abedi More articles by this author , Toronto Toronto More articles by this author , Canada Canada More articles by this author , Thenappan ChandrasekarThenappan Chandrasekar More articles by this author , PA PhiladelphiaPA Philadelphia More articles by this author , Kartik JhaveriKartik Jhaveri More articles by this author , Toronto Toronto More articles by this author , Canada Canada More articles by this author , Johan BjorklundJohan Bjorklund More articles by this author , Stockholm Stockholm More articles by this author , Sweden Sweden More articles by this author , Douglas CheungDouglas Cheung More articles by this author , Michael JewettMichael Jewett More articles by this author , and Antonio FinelliAntonio Finelli More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003322.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The incidence of incidentally-detected renal cysts is high, ranging from 12% to 61%. While well-defined clinical consensus exists for Bosniak I and II renal cysts, our understanding of best practices for surveillance and management of complex renal cysts remains contended. This study aimed to evaluate key patient and disease-specific outcomes of complex renal cysts across an updated, twenty-year cohort. METHODS: We performed a retrospective chart review of patients diagnosed with Bosniak IIF, III and IV renal cysts from 2001-2013 across three tertiary academic hospitals. Data from date of diagnosis to June 2022 was extracted, including demographics, cyst characteristics, biopsy and surgical/ablative intervention. Primary endpoints were radiologic upgrading (i.e. formal Bosniak upgrading or subjective worsening of radiographic features in same Bosniak class) and cancer-specific mortality. RESULTS: A total of 332 patients with complex renal cysts were included: Bosniak IIF (55.4%, 184/332), Bosniak III (36.4%, 121/332), Bosniak IV (8.1%, 27/332). The majority of patients were male (63.3%, 210/332). Most patients were managed with active surveillance, except Bosniak IV patients where 66.7% (18/27) underwent upfront nephrectomy. Rates of biopsy were similar among Bosniak III and IV groups (22.3%, 27/121 and 22.2%, 6/27). Median follow-up for Bosniak IIF, III and Bosniak IV cysts on active surveillance was 7.8 years (IQR= 3.9-12.4 yrs), 6.6 years (IQR= 3.7-10.1 yrs) and 4.6 years (IQR=3.7-8.6 yrs), respectively. Twenty-eight percent of surgical patients (19/67) experienced peri-operative complications. The rate of radiologic upgrading for Bosniak IIF, III and IV was 7.1% (13/184), 4.9% (6/121) and 3.7% (1/27), respectively (Table 1). Cancer-specific mortality remained at 0.3% (1/332). CONCLUSIONS: Overall, despite lengthy follow-up, the rate of radiologic progression and cancer-specific mortality for complex renal cysts remains low. This analysis challenges conventional views of upfront intervention, particularly for Bosniak III cysts. It appears safe to de-intensify surveillance for complex renal cysts along with transfer of care to primary care providers (with appropriate direction and triggers for re-referral), especially for patients with compatible goals of care. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e881 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hannah Thomas More articles by this author Shideh Abedi More articles by this author Toronto More articles by this author Canada More articles by this author Thenappan Chandrasekar More articles by this author PA Philadelphia More articles by this author Kartik Jhaveri More articles by this author Toronto More articles by this author Canada More articles by this author Johan Bjorklund More articles by this author Stockholm More articles by this author Sweden More articles by this author Douglas Cheung More articles by this author Michael Jewett More articles by this author Antonio Finelli More articles by this author Expand All Advertisement PDF downloadLoading ...

Evolution of Bosniak IIF Renal Cysts and Impact of the 2019 Bosniak Classification. Reply.

No AccessJournal of UrologyReply to Letters to the Editor14 Feb 2023Clinical Outcomes of Bosniak IIF Renal Cysts and Impact of the 2019 Bosniak Classification. Reply.is a reply to letterEvolution of Bosniak IIF Renal Cysts and Impact of the 2019 Bosniak Classification. Letter. Patrick O. Richard and Felix Couture Patrick O. RichardPatrick O. Richard * E-mail Address: [email protected] Department of Urology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada More articles by this author and Felix CoutureFelix Couture Department of Urology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003366AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookLinked InTwitterEmail "Clinical Outcomes of Bosniak IIF Renal Cysts and Impact of the 2019 Bosniak Classification. Reply.." The Journal of Urology, Publish Ahead of Print, pp. – REFERENCES 1. . Evolution of Bosniak IIF renal cysts and impact of the 2019 Bosniak classification. J Urol.2023; 209(5):000-000. Link, Google Scholar 2. . Bosniak classification for complex renal cysts reevaluated: a systematic review. J Urol.2017; 198(1):12-21. Link, Google Scholar 3. . Proportion of malignancy in Bosniak classification of cystic renal masses version 2019 (v2019) classes: systematic review and meta-analysis. Eur Radiol.2022; 33(2):1307-1317. Crossref, Medline, Google Scholar 4. . Outcomes of Bosniak classification version 2019 class IIF cystic renal masses at imaging surveillance. AJR Am J Roentgenol.2022. Crossref, Google Scholar Submitted February 2, 2023; accepted February 3, 2023; published 000. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of Urology14 Feb 2023Evolution of Bosniak IIF Renal Cysts and Impact of the 2019 Bosniak Classification. Letter. Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Patrick O. Richard Department of Urology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada * E-mail Address: [email protected] More articles by this author Felix Couture Department of Urology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada More articles by this author Expand All Submitted February 2, 2023; accepted February 3, 2023; published 000. Advertisement PDF downloadLoading ...

Contrast-enhanced ultrasonography in the differential diagnosis of complex renal cysts and small renal masses

BackgroundRenal masses can be divided into complex cysts and solid lesions. The Bosniak classification divides renal cysts into IV categories bases on different criteria. Based on this characterization, a decision about further management can be made. Sonography or contrast-enhanced sonography is one of the standard diagnostic procedures for renal cysts and is a useful method for classification into the Bosniak categories.ObjectivesThis review describes cystic kidney lesions and their differentiation using contrast-enhanced sonography, which is intended to support further management.Materials and methodsA selective literature search and evaluation of the own patient collective were carried out for the preparation of the review.ConclusionContrast-enhanced sonography is a simple and inexpensive technique. In the evaluation of complex renal cysts and small solid renal masses, it allows rapid determination of the appropriate therapeutic approach, especially since additional information about the vascularization of the renal masses is obtained.

Additional value of microvascular flow imaging inthe assessment of cystic and solid renal lesions.

Contrast enhanced ultrasound (CEUS) is increasingly used in the evaluation of renal lesions, however, its availability remains limited. Thus, sensitive noncontrast ultrasound evaluation of renal lesion vascularity is an unmet need. In this single-center, retrospective study we assessed microvascular flow imaging (MV-flow) compared to CEUS in the evaluation of complex renal cysts and solid lesions. Out of 92 patients 28 were evaluated with both CEUS and MV-flow. Color Doppler, CEUS, and MV-flow was performed in 13 cases, whilst MV-flow, CEUS, and contrast-enhanced MV-flow (CE-MV-flow) was done in 16 cases. The CEUS diagnosis was considered gold standard. MV-flow showed a substantial agreement with the CEUS diagnosis (weighted Kappa = 0.806), excluding equivocal lesions (Bosniak 2F). MV-flow substantially outperformed color Doppler (weighted Kappa = 0.77 vs. 0.133). The agreement of CE-MV-flow and MV-flow was comparable (weighted Kappa = 0.79 vs. 0.69). MV-flow significantly improves evaluation of renal lesion vascularity compared to conventional techniques. However, the sensitivity is limited for equivocal lesions (e.g. Bosniak 2F cysts). Thus, MV-flow should be used as an ancillary technique, not as a substitute to CEUS. Current MV-flow presets are ill-suited for postcontrast imaging, therefore specific presets optimized for this purpose are needed to establish its potential.

Active surveillance for complex renal cysts: is it time for III-F and IV-F?

Active surveillance for complex renal cysts: is it time for III-F and IV-F?

Locally Aggressive Mixed Epithelial and Stromal Tumour of Kidney Leading to Nephron Loss.

Mixed epithelial and stromal tumour (MEST) is a rare benign renal tumour. It is mainly found in perimenopausal women. We present a case of a 42-year female with no known comorbid who was presented in the outpatient clinic for the right flank pain. Contrast-enhanced CT scan revealed a complex renal cyst with internal septations. Considering a large symptomatic cyst and the presence of internal septations, she was planned for cyst excision. Peroperatively, significant disease progression and loss of renal parenchyma were noted contrary to preoperative scan. Histopathology of the specimen revealed MEST. We demonstrate that MEST of the kidney may have an aggressive local behaviour leading to nephron loss. Key Words: Mixed epithelial and stromal tumour, Kidney, Benign, Renal neoplasm.

Volumetric Quantitative Contrast-enhanced Ultrasonography Evaluation of Complex Renal Cysts: An Adjunctive Metric to the Bosniak Classification System to Predict Malignancy

BackgroundManagement of complex renal cysts is guided by the Bosniak classification system, which may be inadequate for risk stratification of patients for intervention. Fractional tumor vascularity (FV) calculated from volumetric contrast-enhanced ultrasound (CEUS) images may provide additional useful information. ObjectiveTo evaluate CEUS and FV calculation for risk stratification of patients with complex renal cysts. Design, setting, and participantsThis was a pilot prospective study with institutional review board approval involving patients undergoing surgery for Bosniak IIF–IV complex renal cysts. CEUS was performed preoperatively on the day of surgery with two-dimensional (2D) and three-dimensional (3D) imaging and sulfur hexafluoride lipid-type A microspheres as the ultrasound contrast agent. Outcome measurements and statistical analysisA custom MATLAB program was used to select regions of interest on CEUS scans. FV was calculated according to FV = 1 − (total nonenhancing area/total lesion area). We assessed the ability of 2D- and 3D-derived percentage FV (2DFV%, and 3DFV%) and Bosniak classification schemes (pre-2019 [P2019B] and post-2019 [B2019]) to predict malignancy, aggressive histology, and upstaging on surgical pathology. Performance was assessed as area under the receiver operating characteristic curve (AUC). Results and limitationsTwenty eligible patients were included in final analysis, of whom 85% (n = 17) had Bosniak IV cysts and 85% (n = 17) had malignant disease on final pathology. Four (24%) of the malignant lesions were International Society of Urological Pathology grade 3–4. The AUC for predicting malignancy was 0.980, 0.824, 0.863, and 0.824 with P2019B, B2019, 2DFV%, and 3DFV%, respectively. When the Bosniak classification was combined with FV%, three models had an AUC of 1, while the combined 2DFV% + B2019 model had AUC of 0.980. ConclusionsFV is a novel metric for evaluating complex cystic renal masses and enhances the ability of the Bosniak classification system to predict malignancy. This metric may serve as an adjunct in risk stratification for surgical intervention. Further prospective evaluation is warranted. Patient summaryCysts in the kidney are currently classified using a scheme called the Bosniak system. We assessed measurement of the percentage of vascular tissue (called fractional vascularity) in cysts on a special type of ultrasound scan. This promising test adds information when combined with the Bosniak system and can help in guiding appropriate treatment.

MP33-04 CONTRAST-ENHANCED ULTRASONOGRAPHY FOR THE EVALUATION OF COMPLEX RENAL CYSTS

You have accessJournal of UrologyCME1 May 2022MP33-04 CONTRAST-ENHANCED ULTRASONOGRAPHY FOR THE EVALUATION OF COMPLEX RENAL CYSTS Cassra Clark, Corinne Wessner, Shuo Wang, Andrew Denisenko, Andrew Shumaker, Joonyau Leong, Andrea Quinn, Erica Mann, Lydia Glick, Timothy Han, Kibo Nam, Katherine Smentkowski, John Eisenbrey, Leonard Gomella, Edouard Trabulsi, Costas Lallas, Mark Mann, James Mark, Flemming Forsberg, Andrej Lyshchik, Ethan Halpern, and Thenappan Chandrasekar Cassra ClarkCassra Clark More articles by this author , Corinne WessnerCorinne Wessner More articles by this author , Shuo WangShuo Wang More articles by this author , Andrew DenisenkoAndrew Denisenko More articles by this author , Andrew ShumakerAndrew Shumaker More articles by this author , Joonyau LeongJoonyau Leong More articles by this author , Andrea QuinnAndrea Quinn More articles by this author , Erica MannErica Mann More articles by this author , Lydia GlickLydia Glick More articles by this author , Timothy HanTimothy Han More articles by this author , Kibo NamKibo Nam More articles by this author , Katherine SmentkowskiKatherine Smentkowski More articles by this author , John EisenbreyJohn Eisenbrey More articles by this author , Leonard GomellaLeonard Gomella More articles by this author , Edouard TrabulsiEdouard Trabulsi More articles by this author , Costas LallasCostas Lallas More articles by this author , Mark MannMark Mann More articles by this author , James MarkJames Mark More articles by this author , Flemming ForsbergFlemming Forsberg More articles by this author , Andrej LyshchikAndrej Lyshchik More articles by this author , Ethan HalpernEthan Halpern More articles by this author , and Thenappan ChandrasekarThenappan Chandrasekar More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002587.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Complex renal cysts are evaluated using the Bosniak classification system. However, they remain difficult to manage because inter-reader variability and subjective interpretation of the Bosniak system. This pilot study intends to evaluate the use of contrast-enhanced ultrasonography (CEUS) to differentiate the solid and cystic components of complex renal cysts and compare these results to the final surgical pathology report. METHODS: 23 patients undergoing surgery for Bosniak 2F-4 lesions participated in this IRB-approved pilot study. Patients were scanned prior to surgery with both 2D and 3D ultrasound exams. Each injection consisted of a 2.0 mL bolus injection of Lumason contrast (Bracco Imaging, Monroe Township, NJ) followed by a 10 mL saline flush. A custom MATLAB program was used for selection of regions of interest (ROIs) (Figure 1). Fractional tumor vascularity (FTV in %) was then calculated and compared to estimated solid component on the final pathology report.Fractional Tumor Vascularity = 1 − (Total Non-enhancing area/Total lesion area) The primary endpoint of this study was the correlation of 2D/3D-derived fractional vascularity with pathological estimation and tumor staging on explant. RESULTS: No adverse events were observed during any contrast agent administration. Data was analyzed on 22 of 23 patients (Patient 22 excluded due to poor image quality). Mean age was 60.9±15.0 years (range 30 to 85) and mean preoperative lesion size was 4.0±1.6 cm (range 1.2 to 8.3 cm). Nine patients had radical nephrectomies and 14 had a partial nephrectomy. On final pathology, 4 lesions were benign and 19 were malignant. The results of 2D and 3D analysis as well as final pathology are included in Table 1. In general, malignant lesions and more aggressive histology had higher FTV. CONCLUSIONS: Quantitative 2D and 3D CEUS can evaluate FTV of potentially malignant complex cystic renal masses, which may be able to augment current radiographic classification systems. Source of Funding: N/A © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e570 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Cassra Clark More articles by this author Corinne Wessner More articles by this author Shuo Wang More articles by this author Andrew Denisenko More articles by this author Andrew Shumaker More articles by this author Joonyau Leong More articles by this author Andrea Quinn More articles by this author Erica Mann More articles by this author Lydia Glick More articles by this author Timothy Han More articles by this author Kibo Nam More articles by this author Katherine Smentkowski More articles by this author John Eisenbrey More articles by this author Leonard Gomella More articles by this author Edouard Trabulsi More articles by this author Costas Lallas More articles by this author Mark Mann More articles by this author James Mark More articles by this author Flemming Forsberg More articles by this author Andrej Lyshchik More articles by this author Ethan Halpern More articles by this author Thenappan Chandrasekar More articles by this author Expand All Advertisement PDF DownloadLoading ...

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%.

Simple Cysts of the Kidney: A Review and Update

Simple Cysts of the Kidney: A Review and Update

Possibilities of Multiparametric Ultrasound Study with Contrast Enhanced in the Diagnostics of Cistic Kidney Lesions

Purpose: To compare the capabilities and evaluate the effectiveness of gray-scale B-mode, Doppler mapping and contrast enhanced in the assessment of cystic renal lesions.Material and methods: Ultrasound examination (US) was performed in 61 patients with cystic kidney formations (category Bosniak ≥ II). Cysts of categories Bosniak ≥ III were histologically verified, rest (categories II–IIF) were under follow up. All patients underwent gray-scale ultrasound, color Doppler imaging and contrast enhanced (CEUS).Results: The efficiency of the B mode was: sensitivity 55.6 %; specificity 72.1 %; accuracy 62.3 %, in the CDI mode these indicators were 52.8; 80.1; 63.9 %, respectively. Contrast ultrasound significantly increased the capabilities of the method, and also made it possible to evaluate cystic formations according to the Bosniak criteria with indicators of the effectiveness of the method up to 100.0; 92.0; 96.7 %, respectively.Conclusions: CEUS demonstrated high informative value in the assessment of renal cystic formations in comparison with native ultrasound and Doppler modes, and therefore the technique should be considered as promising for inclusion in the algorithm of examination of complex renal cysts.

Role of contrast-enhanced ultrasound in assessing indeterminate renal lesions and Bosniak ≥2F complex renal cysts found incidentally on CT or MRI.

Objective:To investigate the impact of contrast-enhanced ultrasound (CEUS) in reclassifying incidental renal findings categorized as indeterminate lesions (IL) or Bosniak ≥ 2F complex renal cysts (CRC) on CT or MRI.Methods:We retrospectively included 44 subjects who underwent CEUS between 2016 and 2019 to assess 48 IL (n = 12) and CRC (n = 36) incidentally found on CT or MRI. CEUS was performed by one radiologist with 10 year of experience with a sulfur hexafluoride-filled microbubble contrast agent. The same radiologist, blinded to clinical information and previous CT/MRIs, retrospectively reviewed CEUS images/videos, categorizing renal findings with Bosniak-derived imaging categories ranging from 0 (indeterminate) to 5 (solid lesion). CEUS-related reclassification rate was calculated (proportion of IL reclassified with an imaging category >0, or CRC reclassified below or above imaging category >2F). Using histological examination or a ≥ 24 months follow-up as the standard of reference, we also estimated per-lesion sensitivity/specificity for malignancy.Results:CEUS reclassified 24/48 findings (50.0%; 95% C.I. 35.2–64.7), including 12/12 IL (100%; 95% CI 73.5–100) and 12/36 CRC (33.3%; 95% C.I. 18.5–50.9), mostly above category >2F (66.7%). CEUS and CT/MRI showed 96.0% (95%CI 79.7–99.9) vs 44.0% (95%CI 24.4–65.1) sensitivity, and 82.6% (95%CI 61.2–95.1) vs 60.9% (95%CI 38.5–80.3%) specificity.Conclusion:CEUS provided substantial and accurate reclassification of CT/MRI incidental findings.Advances in knowledge:Previous studies included Bosniak 2 incidental findings, thus possibly underestimating CEUS-induced reclassification rates. Using a more meaningful cut-off (Bosniak ≥2F), problem-solving CEUS was effective as well, with higher reclassification rates for CRC than in literature.

Is CEUS the future for imaging complex renal cysts? Are we on the threshold of a change?

Is CEUS the future for imaging complex renal cysts? Are we on the threshold of a change?