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Wang T, Yang H, Hao D, Nie P, Liu Y, Huang C, Huang Y, Wang H, Niu H. A CT-based radiomics nomogram for distinguishing between malignant and benign Bosniak IIF masses: a two-centre study. Clin Radiol 2023; 78:590-600. [PMID: 37258333 DOI: 10.1016/j.crad.2023.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 03/19/2023] [Accepted: 04/24/2023] [Indexed: 06/02/2023]
Abstract
AIM To establish and assess a computed tomography (CT)-based radiomics nomogram for identifying malignant and benign Bosniak IIF masses. MATERIALS AND METHODS In total, 150 patients with Bosniak IIF masses were separated into a training set (n=106) and a test set (n=44) in a ratio of 7:3. A radiomics signature was calculated based on extracted features from the three phases of CT images. A clinical model was constructed based on clinical characteristics and CT features, and a nomogram incorporating the radiomics signature and independent clinical variables was established. The calibration ability, discrimination accuracy, and clinical value of the nomogram model were assessed. RESULTS Twelve features derived from CT images were applied to establish the radiomics signature. The performance levels of three machine-learning models were improved by adding the synthetic minority oversampling technique algorithm. The optimised machine learning model was a combination of the minimum redundancy maximum relevance-least absolute shrinkage and selection operator feature screening method + logistic regression classifier + synthetic minority oversampling technique algorithm, which demonstrated excellent identification ability on the test set (area under the curve [AUC], 0.970; 95% confidence interval [CI], 0.940-1.000). The nomogram model displayed outstanding discrimination ability on the test set (AUC, 0.972; 95% CI, 0.942-1.000). CONCLUSIONS The CT-based radiomics nomogram was useful for discriminating between malignant and benign Bosniak IIF masses, which improved the precision of preoperative diagnosis.
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Affiliation(s)
- T Wang
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - H Yang
- Institute for Future (IFF), Qingdao University, Qingdao, Shandong, China
| | - D Hao
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - P Nie
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Y Liu
- Institute for Future (IFF), Qingdao University, Qingdao, Shandong, China
| | - C Huang
- Department of Research Collaboration, R&D Center, Beijing Deepwise & League of PHD Technology Co., Ltd, Beijing, China
| | - Y Huang
- Department of Radiology, The Puyang City Oilfield General Hospital, Puyang, Henan, China
| | - H Wang
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
| | - H Niu
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
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Zeng SE, Du MY, Yu Y, Huang SY, Zhang D, Cui XW, Dietrich CF. Ultrasound, CT, and MR Imaging for Evaluation of Cystic Renal Masses. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:807-819. [PMID: 34101225 DOI: 10.1002/jum.15762] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/12/2021] [Accepted: 05/23/2021] [Indexed: 06/12/2023]
Abstract
Cystic renal masses are often encountered during abdominal imaging. Although most of them are benign simple cysts, some cystic masses have malignant characteristics. The Bosniak classification system provides a useful way to classify cystic masses. The Bosniak classification is based on the results of a well-established computed tomography protocol. Over the past 30 years, the classification system has been refined and improved. This paper reviews the literature on this topic and compares the advantages and disadvantages of different screening and classification methods. Patients will benefit from multimodal diagnosis for lesions that are difficult to classify after a single examination.
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Affiliation(s)
- Shu-E Zeng
- Department of Ultrasound Medicine, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ming-Yue Du
- Department of Ultrasound Medicine, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yang Yu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shu-Yan Huang
- Department of Ultrasound, The First People's Hospital of Huaihua, Huaihua, China
| | - Di Zhang
- Department of Medical Ultrasound, Affiliated Hospital of Nantong University, Nantong, China
| | - Xin-Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Xiaojuan Y, Huihui Y, Yu H. Diagnostic Values of CEUS, CECT and CEMRI for Renal Cystic Lesions on the Current Bosniak Criterion-A Meta-analysi. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2022. [DOI: 10.37015/audt.2022.210037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Pourvaziri A, Parakh A, Biondetti P, Sahani D, Kambadakone A. Abdominal CT manifestations of adverse events to immunotherapy: a primer for radiologists. Abdom Radiol (NY) 2020; 45:2624-2636. [PMID: 32451672 DOI: 10.1007/s00261-020-02531-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Immunotherapy is a rapidly growing field within oncology and is being increasingly used in the management of several malignancies. Due to their unique mechanism of action on the immune system and neoplastic cells, the response pattern and adverse events of this novel therapy are distinct from conventional systemic therapies. Accordingly, the imaging appearances following immunotherapy including adverse events are unique and at times perplexing. Imaging is integral to management of patients on immunotherapeutic agents and a thorough understanding of its mechanism, response patterns and adverse events is crucial for precise interpretation of imaging studies. This review provides a description of the mechanism of action of current immunotherapeutic agents and the organ-wise description of their side effects.
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Affiliation(s)
- Ali Pourvaziri
- Division of Abdominal Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, White 270, Boston, MA, 02114, USA
| | - Anushri Parakh
- Division of Abdominal Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, White 270, Boston, MA, 02114, USA
| | - Pierpaolo Biondetti
- Division of Abdominal Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, White 270, Boston, MA, 02114, USA
| | - Dushyant Sahani
- Department of Radiology, University of Washington, UWMC Radiology RR218, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Avinash Kambadakone
- Division of Abdominal Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, White 270, Boston, MA, 02114, USA.
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Hélénon O, Crosnier A, Verkarre V, Merran S, Méjean A, Correas JM. Simple and complex renal cysts in adults: Classification system for renal cystic masses. Diagn Interv Imaging 2018; 99:189-218. [DOI: 10.1016/j.diii.2017.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 09/26/2017] [Indexed: 02/08/2023]
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Richard PO, Violette PD, Jewett MAS, Pouliot F, Leveridge M, So A, Whelan TF, Rendon R, Finelli A. CUA guideline on the management of cystic renal lesions. Can Urol Assoc J 2017; 11:E66-E73. [PMID: 28360949 DOI: 10.5489/cuaj.4484] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Patrick O Richard
- Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Sherbrooke and Centre de recherche du CHUS, Université de Sherbrooke, Sherbrooke, QC, Canada
| | | | - Michael A S Jewett
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada
| | - Frederic Pouliot
- Division of Urology, Department of Surgery, Université Laval, Centre de Recherche du Centre Hospitalier Universitaire de Québec, Quebec City, QC, Canada
| | - Michael Leveridge
- Department of Urology, Queen's University, Kingston General Hospital, Kingston, ON, Canada
| | - Alan So
- Division of Urology, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Thomas F Whelan
- Division of Urology, Department of Surgery, Saint John Regional Hospital, Dalhousie University, Saint John, NB
| | - Ricardo Rendon
- Department of Urology, QEII Health Sciences Centre, Dalhousie University, Halifax, NS
| | - Antonio Finelli
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada
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Sevcenco S, Spick C, Helbich TH, Heinz G, Shariat SF, Klingler HC, Rauchenwald M, Baltzer PA. Malignancy rates and diagnostic performance of the Bosniak classification for the diagnosis of cystic renal lesions in computed tomography - a systematic review and meta-analysis. Eur Radiol 2016; 27:2239-2247. [PMID: 27761710 PMCID: PMC5408031 DOI: 10.1007/s00330-016-4631-9] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 09/28/2016] [Accepted: 10/03/2016] [Indexed: 11/04/2022]
Abstract
Objective To systematically review the literature on the Bosniak classification system in CT to determine its diagnostic performance to diagnose malignant cystic lesions and the prevalence of malignancy in Bosniak categories. Methods A predefined database search was performed from 1 January 1986 to 18 January 2016. Two independent reviewers extracted data on malignancy rates in Bosniak categories and several covariates using predefined criteria. Study quality was assessed using QUADAS-2. Meta-analysis included data pooling, subgroup analyses, meta-regression and investigation of publication bias. Results A total of 35 studies, which included 2,578 lesions, were investigated. Data on observer experience, inter-observer variation and technical CT standards were insufficiently reported. The pooled rate of malignancy increased from Bosniak I (3.2 %, 95 % CI 0–6.8, I2 = 5 %) to Bosniak II (6 %, 95 % CI 2.7–9.3, I2 = 32 %), IIF (6.7 %, 95 % CI 5–8.4, I2 = 0 %), III (55.1 %, 95 % CI 45.7–64.5, I2 = 89 %) and IV (91 %, 95 % CI 87.7–94.2, I2 = 36). Several study design-related influences on malignancy rates and subsequent diagnostic performance indices were identified. Conclusion The Bosniak classification is an accurate tool with which to stratify the risk of malignancy in renal cystic lesions. Key points • The Bosniak classification can accurately rule out malignancy. • Specificity remains moderate at 74 % (95 % CI 64–82). • Follow-up examinations should be considered in Bosniak IIF and Bosniak II cysts. • Data on the influence of reader experience and inter-reader variability are insufficient. • Technical CT standards and publication year did not influence diagnostic performance. Electronic supplementary material The online version of this article (doi:10.1007/s00330-016-4631-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sabina Sevcenco
- Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Claudio Spick
- Department of Biomedical Imaging and Image-guided Therapy, General Hospital Vienna, Medical University of Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, General Hospital Vienna, Medical University of Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria
| | - Gertraud Heinz
- Department of Radiology, University Hospital of Sankt-Pölten, Propst-Führer-Straße 4, 3100 St., Pölten, Austria
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Hans C Klingler
- Department of Urology, Wilhelminenspital, Montleartstraße 37, 1160, Vienna, Austria
| | - Michael Rauchenwald
- Department of Urology, Donauspital, Langobardenstraße 122, 1220, Vienna, Austria
| | - Pascal A Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, General Hospital Vienna, Medical University of Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria.
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Hélénon O, Delavaud C, Dbjay J, Gregory J, Rasouli N, Correas JM. A Practical Approach to Indeterminate and Cystic Renal Masses. Semin Ultrasound CT MR 2016; 38:10-27. [PMID: 28237276 DOI: 10.1053/j.sult.2016.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Cystic renal masses are a common entity with a wide differential diagnosis encountered by the radiologist in daily practice. Their characterization relies on the Bosniak classification system that has been widely accepted by radiologists and urologists as a pertinent diagnostic and communication tool. It has been designed to separate cystic lesions requiring surgery (categories III and IV) from those that can be ignored and left alone (categories I and II) or followed (category IIF). Utilization of the Bosniak classification requires, first, previous identification of the cystic nature of a renal mass with the exception of very small lesions.
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Affiliation(s)
- Olivier Hélénon
- Paris Descartes Medical School, Paris Descartes University, Paris, France; Department of Adult Radiology, Necker Hospital, Paris, France.
| | - Christophe Delavaud
- Paris Descartes Medical School, Paris Descartes University, Paris, France; Department of Adult Radiology, Necker Hospital, Paris, France
| | - Jonathan Dbjay
- Paris Descartes Medical School, Paris Descartes University, Paris, France; Department of Adult Radiology, Necker Hospital, Paris, France
| | - Jules Gregory
- Paris Descartes Medical School, Paris Descartes University, Paris, France; Department of Adult Radiology, Necker Hospital, Paris, France
| | | | - Jean-Michel Correas
- Paris Descartes Medical School, Paris Descartes University, Paris, France; Department of Adult Radiology, Necker Hospital, Paris, France
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Lan D, Qu HC, Li N, Zhu XW, Liu YL, Liu CL. The Value of Contrast-Enhanced Ultrasonography and Contrast-Enhanced CT in the Diagnosis of Malignant Renal Cystic Lesions: A Meta-Analysis. PLoS One 2016; 11:e0155857. [PMID: 27203086 PMCID: PMC4874594 DOI: 10.1371/journal.pone.0155857] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 05/05/2016] [Indexed: 12/12/2022] Open
Abstract
We compared the efficacy of contrast-enhanced ultrasound (CEUS) and contrast-enhanced computed tomography (CECT) for the diagnosis of renal cystic lesions via a meta-analysis to determine the value of CEUS in the prediction of the malignant potential of complex renal cysts. Eleven studies were evaluated: 4 control studies related to CEUS and CECT, 3 studies related to CEUS and 4 studies related to CECT. According to the random effects model, the pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio for CEUS/CECT were 0.95/0.90, 0.79/0.85, 4.39/5.00, and 0.10/0.15, respectively. The areas under the summary receiver operating characteristic (AUCs-SROC) curves for the two methods were 94.24% and 93.39%, and the estimated Q values were 0.8805 and 0.8698, respectively. Comparing the Q index values of CEUS and CECT revealed no significant difference between the two methods (P>0.05). When compared with conventional CECT, CEUS is also useful for diagnosing renal cystic lesions in the clinic.
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Affiliation(s)
- Dong Lan
- Department of Urological Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, P.R. China
| | - Hong-Chen Qu
- Department of Urological Surgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital & Institute, Shenyang, Liaoning, P.R. China
| | - Ning Li
- Department of Urological Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, P.R. China
| | - Xing-Wang Zhu
- Department of Urological Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, P.R. China
| | - Yi-Li Liu
- Department of Urological Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, P.R. China
| | - Chun-Lai Liu
- Department of Urological Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, P.R. China
- * E-mail:
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Bradley AJ, MacDonald L, Whiteside S, Johnson RJ, Ramani VAC. Accuracy of preoperative CT T staging of renal cell carcinoma: which features predict advanced stage? Clin Radiol 2015; 70:822-9. [PMID: 25953656 DOI: 10.1016/j.crad.2015.03.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 03/01/2015] [Accepted: 03/24/2015] [Indexed: 01/13/2023]
Abstract
AIMS To characterise CT findings in renal cell carcinoma (RCC), and establish which features are associated with higher clinical T stage disease, and to evaluate patterns of discrepancy between radiological and pathological staging of RCC. MATERIALS AND METHODS Preoperative CT studies of 92 patients with 94 pathologically proven RCCs were retrospectively reviewed. CT stage was compared with pathological stage using the American Joint Committee on Cancer (AJCC), 7(th) edition (2010). The presence or absence of tumour necrosis, perinephric fat standing, thickening of Gerota's fascia, collateral vessels were noted, and correlated with pT stage. The sensitivity, specificity, and positive (PPV) and negative predictive values (NPV) for predicting pT stage ≥pT3a were derived separately for different predictors using cross-tabulations. RESULTS Twenty-four lesions were pathological stage T1a, 21 were T1b, seven were T2a, 25 were T3a, 11 were T3b, four were T3c, and two were T4. There were no stage T2b. Sixty-three (67%) patients had necrosis, 27 (29%) thickening of Gerota's fascia (1 T1a), 25 had collateral vessels (0 T1a), 28 (30%) had fat stranding of <2 mm, 20 (21%) of 2-5mm and one (1%) of >5 mm. For pT stage ≥pT3a, the presence of perinephric fat stranding had a sensitivity, specificity, PPV and NPV of 74%, 65%, 63%, and 76%, respectively. Presence of tumour necrosis had a sensitivity, specificity, PPV, and NPV of 81%, 44%, 54%, and 72%, respectively. Thickening of Gerota's fascia had a sensitivity, specificity, PPV, and NPV of 52%, 90%, 81% and 70%, respectively; and enlarged collateral vessels had a sensitivity, specificity, PPV, and NPV value of 52%, 94%, 88%, and 71% respectively. CONCLUSION The presence of perinephric stranding and tumour necrosis were not reliable signs for pT stage >T3a. Thickening of Gerota's fascia and the presence of collateral vessels in the peri- or paranephric fat had 90% and 94% specificity, with 82% and 88% PPV, respectively, for the presence of tumour stage for pT stage >T3a. These are considered reliable signs of locally advanced renal cancer.
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Affiliation(s)
- A J Bradley
- Department of Radiology, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK.
| | - L MacDonald
- Department of Radiology, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK
| | - S Whiteside
- Department of Medical Statistics, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK
| | - R J Johnson
- Department of Radiology, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK
| | - V A C Ramani
- Department of Urology, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK
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