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Barkovich KJ, Gibson AC, Brahmbhatt S, Tadisetty S, Wilds EC, Nelson LW, Gupta M, Gedaly R, Khurana A. Contrast-enhanced ultrasound of renal masses in the pre-transplant setting: literature review with case highlights. Abdom Radiol (NY) 2024:10.1007/s00261-024-04366-w. [PMID: 38900316 DOI: 10.1007/s00261-024-04366-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 04/29/2024] [Accepted: 04/29/2024] [Indexed: 06/21/2024]
Abstract
With the rising incidence of chronic kidney disease worldwide, an increasing number of patients are expected to require renal transplantation, which remains the definitive treatment of end stage renal disease. Medical imaging, primarily ultrasonography and contrast-enhanced CT and/or MRI, plays a large role in pre-transplantation assessment, especially in the characterization of lesions within the native kidneys. However, patients with CKD/ESRD often have relative contraindications to CT- and MR-contrast agents, limiting their utilization within this patient population. Contrast-enhanced ultrasound (CEUS), which combines the high temporal and spatial resolution of ultrasonography with intravascular microbubble contrast agents, provides a promising alternative. This review aims to familiarize the reader with the literature regarding the use of CEUS in the evaluation of cystic and solid renal lesions and provide case examples of its use at our institution in the pre-transplant setting.
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Affiliation(s)
- Krister J Barkovich
- Department of Radiology, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Amanda C Gibson
- Department of Radiology, University of Kentucky, Lexington, KY, 40508, USA
| | - Sneh Brahmbhatt
- Department of Radiology, Mayo Clinic Florida, Jacksonville, FL, 32224, USA
| | - Sindhura Tadisetty
- Department of Radiology, University of Kentucky, Lexington, KY, 40508, USA
| | - Emory C Wilds
- College of Medicine, University of Kentucky, Lexington, KY, 40506, USA
| | - Leslie W Nelson
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53792, USA
| | - Meera Gupta
- Department of Surgery, University of Kentucky, Lexington, KY, 40508, USA
| | - Roberto Gedaly
- Department of Surgery, University of Kentucky, Lexington, KY, 40508, USA
| | - Aman Khurana
- Department of Radiology, University of California, San Diego, La Jolla, CA, 92093, USA.
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Faiella E, Vergantino E, Vaccarino F, Bruno A, Perillo G, Grasso RF, Zobel BB, Santucci D. A Review of the Paradigmatic Role of Adipose Tissue in Renal Cancer: Fat Measurement and Tumor Behavior Features. Cancers (Basel) 2024; 16:1697. [PMID: 38730649 PMCID: PMC11083503 DOI: 10.3390/cancers16091697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/25/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
(1) Background: Renal-cell carcinoma (RCC) incidence has been steadily rising, with obesity identified as a potential risk factor. However, the relationship between obesity and RCC prognosis remains unclear. This systematic review aims to investigate the impact of different adipose tissue measurements on RCC behavior and prognosis. (2) Methods: A search of MEDLINE databases identified 20 eligible studies focusing on various fat measurements, including visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), perirenal adipose tissue (PRAT), and the Mayo adhesive probability (MAP) score. (3) Results: The review revealed conflicting findings regarding the association between adipose tissue measurements and RCC outcomes. While some studies suggested a protective role of certain fat deposits, particularly VAT, against disease progression and mortality, others reported contradictory results across different adipose metrics and RCC subtypes. (4) Conclusions: Methodological variations and limitations, such as retrospective designs and sample size constraints, pose challenges to standardization and generalizability. Further research is needed to understand these associations better and establish standardized approaches for adiposity assessment in RCC patients, which could inform clinical practice and therapeutic decision-making.
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Affiliation(s)
- Eliodoro Faiella
- Operative Reasearch Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, 00128 Rome, Italy; (E.F.); (F.V.); (A.B.); (G.P.); (R.F.G.); (B.B.Z.); (D.S.)
- Research Unit of Radiology and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Elva Vergantino
- Operative Reasearch Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, 00128 Rome, Italy; (E.F.); (F.V.); (A.B.); (G.P.); (R.F.G.); (B.B.Z.); (D.S.)
- Research Unit of Radiology and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Federica Vaccarino
- Operative Reasearch Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, 00128 Rome, Italy; (E.F.); (F.V.); (A.B.); (G.P.); (R.F.G.); (B.B.Z.); (D.S.)
- Research Unit of Radiology and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Amalia Bruno
- Operative Reasearch Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, 00128 Rome, Italy; (E.F.); (F.V.); (A.B.); (G.P.); (R.F.G.); (B.B.Z.); (D.S.)
- Research Unit of Radiology and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Gloria Perillo
- Operative Reasearch Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, 00128 Rome, Italy; (E.F.); (F.V.); (A.B.); (G.P.); (R.F.G.); (B.B.Z.); (D.S.)
- Research Unit of Radiology and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Rosario Francesco Grasso
- Operative Reasearch Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, 00128 Rome, Italy; (E.F.); (F.V.); (A.B.); (G.P.); (R.F.G.); (B.B.Z.); (D.S.)
- Research Unit of Radiology and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Bruno Beomonte Zobel
- Operative Reasearch Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, 00128 Rome, Italy; (E.F.); (F.V.); (A.B.); (G.P.); (R.F.G.); (B.B.Z.); (D.S.)
- Research Unit of Radiology and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Domiziana Santucci
- Operative Reasearch Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, 00128 Rome, Italy; (E.F.); (F.V.); (A.B.); (G.P.); (R.F.G.); (B.B.Z.); (D.S.)
- Research Unit of Radiology and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
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Elbaset MA, Ashour R, Elgamal M, Elbatta A, Ghobrial FK, Abouelkheir RT, Mosbah A, Osman Y. The efficacy of the new Bosniak classification v.2019 in benign lesions prediction within the higher Bosniak cysts classes. Urol Oncol 2023; 41:434.e1-434.e7. [PMID: 37574368 DOI: 10.1016/j.urolonc.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/29/2023] [Accepted: 06/18/2023] [Indexed: 08/15/2023]
Abstract
INTRODUCTION Identification of benign lesions among higher classes of renal Bosniak cysts who are vulnerable to active surveillance instead of surgical approach is still questionable. We aimed in this study to delineate the efficacy of the new Bosniak v2019 classification in benign lesions identification among those cases with higher Bosniak classes in comparison with the final histopathology. MATERIALS In a retrospective review between 2010 and 2021 for patients diagnosed as higher classes Bosniak renal masses was done. Patients' demographics and radiological data i.e.,: age, gender, and final Bosniak v2019 categorization for class III: (1) Enhancing thick wall/septa >4 mm (III-WS) and (2) Enhancing irregular wall/septa or convex protrusion with obtuse margins <3 mm (III-OP) and for class IV as: (1) Enhancing nodule or convex protrusion with obtuse margins >4 mm (IV-OP) and (2) Enhancing nodule or convex protrusion with acute margins of any size (IV-AP). RESULTS A total of 137 patients were included. Bosniak III was identified in 56 patients. Malignancy was detected in 74.5% of resected masses. Among resected Bosniak III cyst, 46.4% were benign histopathologically. Male gender and Bosniak III-OP were independent risks for malignancy among the resected Bosniak III cysts. Conversely, in resected Bosniak IV renal cysts, only 9 of resected masses were benign. In univariate analysis, male gender, absence of multilocular cyst and endophytic masses were predictors for malignancy in resected Bosniak IV cyst. None of the previous predictors was significant in multivariate analysis. CONCLUSION The Bosniak subclassification v.2019 can define benign lesions. Bosniak III-OP was an independent risk for malignancy detection among the resected Bosniak III cysts.
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Affiliation(s)
- Mohamed Abd Elbaset
- Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
| | - Rawdy Ashour
- Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Mostafa Elgamal
- Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ahmed Elbatta
- Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | | | - Rasha T Abouelkheir
- Department of Radiology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ahmed Mosbah
- Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Yasser Osman
- Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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Möller K, Jenssen C, Correas JM, Safai Zadeh E, Bertolotto M, Ignee A, Dong Y, Cantisani V, Dietrich CF. CEUS Bosniak Classification-Time for Differentiation and Change in Renal Cyst Surveillance. Cancers (Basel) 2023; 15:4709. [PMID: 37835403 PMCID: PMC10571952 DOI: 10.3390/cancers15194709] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/12/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
It is time for a change. CEUS is an established method that should be much more actively included in renal cyst monitoring strategies. This review compares the accuracies, strengths, and weaknesses of CEUS, CECT, and MRI in the classification of renal cysts. In order to avoid overstaging by CEUS, a further differentiation of classes IIF, III, and IV is required. A further development in the refinement of the CEUS-Bosniak classification aims to integrate CEUS more closely into the monitoring of renal cysts and to develop new and complex monitoring algorithms.
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Affiliation(s)
- Kathleen Möller
- Medical Department I/Gastroenterology, Sana Hospital Lichtenberg, 10365 Berlin, Germany
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch-Oderland, 15344 Strausberg, Germany
- Brandenburg Institute of Clinical Medicine, Medical University Brandenburg, 16816 Neuruppin, Germany
| | - Jean Michel Correas
- Biomedical Imaging Laboratory, UMR 7371-U114, University of Paris, 75006 Paris, France
| | - Ehsan Safai Zadeh
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Michele Bertolotto
- Department of Radiology, Ospedale di Cattinara, University of Trieste, 34149 Trieste, Italy
| | - André Ignee
- Department of Medical Gastroenterology, Julius-Spital, 97070 Würzburg, Germany
| | - Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Vito Cantisani
- Department of Radiology, Oncology, and Anatomy Pathology, “Sapienza” University of Rome, 00185 Rome, Italy
| | - Christoph F. Dietrich
- Department Allgemeine Innere Medizin, Hirslanden Klinik Beau-Site, 3013 Bern, Switzerland
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Dana J, Gauvin S, Zhang M, Lotero J, Cassim C, Artho G, Bhatnagar SR, Tanguay S, Reinhold C. CT-based Bosniak classification of cystic renal lesions: is version 2019 an improvement on version 2005? Eur Radiol 2023; 33:1297-1306. [PMID: 36048207 DOI: 10.1007/s00330-022-09082-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 07/02/2022] [Accepted: 08/04/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare the diagnostic performance and inter-reader agreement of the CT-based v2019 versus v2005 Bosniak classification systems for risk stratification of cystic renal lesions (CRL). METHODS This retrospective study included adult patients with CRL identified on CT scan between 2005 and 2018. The reference standard was histopathology or a minimum 4-year imaging follow-up. The studies were reviewed independently by five readers (three senior, two junior), blinded to pathology results and imaging follow-up, who assigned Bosniak categories based on the 2005 and 2019 versions. Diagnostic performance of v2005 and v2019 Bosniak classifications for distinguishing benign from malignant lesions was calculated by dichotomizing CRL into the potential for ablative therapy (III-IV) or conservative management (I-IIF). Inter-reader agreement was calculated using Light's Kappa. RESULTS One hundred thirty-nine patients with 149 CRL (33 malignant) were included. v2005 and v2019 Bosniak classifications achieved similar diagnostic performance with a sensitivity of 91% vs 91% and a specificity of 89% vs 88%, respectively. Inter-reader agreement for overall Bosniak category assignment was substantial for v2005 (κ = 0.78) and v2019 (κ = 0.75) between senior readers but decreased for v2019 when the Bosniak classification was dichotomized to conservative management (I-IIF) or ablative therapy (III-IV) (0.80 vs 0.71, respectively). For v2019, wall thickness was the morphological feature with the poorest inter-reader agreement (κ = 0.43 and 0.18 for senior and junior readers, respectively). CONCLUSION No significant improvement in diagnostic performance and inter-reader agreement was shown between v2005 and v2019. The observed decrease in inter-reader agreement in v2019 when dichotomized according to management strategy may reflect the more stringent morphological criteria. KEY POINTS • Versions 2005 and 2019 Bosniak classifications achieved similar diagnostic performance, but the specificity of higher risk categories (III and IV) was not increased while one malignant lesion was downgraded to v2019 Bosniak category II (i.e., not subjected to further follow-up). • Inter-reader agreement was similar between v2005 and v2019 but moderately decreased for v2019 when the Bosniak classification was dichotomized according to the potential need for ablative therapies (I-II-IIF vs III-IV).
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Affiliation(s)
- Jérémy Dana
- Department of Diagnostic Radiology, McGill University Health Center, 1001 Decarie Boul., H4A 3J1, Montréal, Québec, Canada.,Strasbourg University, Inserm U1110, Institut de Recherche sur les Maladies Virales et Hépatiques, Strasbourg, France.,IHU-Strasbourg (Institut Hospitalo-Universitaire), Institute for Minimally Invasive Hybrid Image-Guided Surgery, Université de Strasbourg, Strasbourg, France
| | - Simon Gauvin
- Department of Diagnostic Radiology, McGill University Health Center, 1001 Decarie Boul., H4A 3J1, Montréal, Québec, Canada.,Montreal Imaging Experts Inc., Montreal, Canada
| | - Michelle Zhang
- Department of Diagnostic Radiology, McGill University Health Center, 1001 Decarie Boul., H4A 3J1, Montréal, Québec, Canada.,Montreal Imaging Experts Inc., Montreal, Canada
| | - Jose Lotero
- Department of Diagnostic Radiology, McGill University Health Center, 1001 Decarie Boul., H4A 3J1, Montréal, Québec, Canada
| | - Christopher Cassim
- Department of Diagnostic Radiology, McGill University Health Center, 1001 Decarie Boul., H4A 3J1, Montréal, Québec, Canada
| | - Giovanni Artho
- Department of Diagnostic Radiology, McGill University Health Center, 1001 Decarie Boul., H4A 3J1, Montréal, Québec, Canada.,Montreal Imaging Experts Inc., Montreal, Canada
| | - Sahir Rai Bhatnagar
- Department of Diagnostic Radiology, McGill University Health Center, 1001 Decarie Boul., H4A 3J1, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University Health Center, Montréal, Québec, Canada
| | - Simon Tanguay
- Department of Urology, McGill University Health Center, Montréal, Québec, Canada
| | - Caroline Reinhold
- Department of Diagnostic Radiology, McGill University Health Center, 1001 Decarie Boul., H4A 3J1, Montréal, Québec, Canada. .,Montreal Imaging Experts Inc., Montreal, Canada. .,Augmented Intelligence & Precision Health Laboratory of the Research Institute of McGill University Health Centre, Montreal, Canada.
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Dana J, Lefebvre TL, Savadjiev P, Bodard S, Gauvin S, Bhatnagar SR, Forghani R, Hélénon O, Reinhold C. Malignancy risk stratification of cystic renal lesions based on a contrast-enhanced CT-based machine learning model and a clinical decision algorithm. Eur Radiol 2022; 32:4116-4127. [DOI: 10.1007/s00330-021-08449-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/17/2021] [Accepted: 10/29/2021] [Indexed: 01/06/2023]
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Murakami M, Heng HG, Sola M. CT features of confirmed and presumed gastric wall edema in dogs. Vet Radiol Ultrasound 2022; 63:711-718. [PMID: 35674240 PMCID: PMC9796106 DOI: 10.1111/vru.13123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/02/2022] [Accepted: 03/08/2022] [Indexed: 12/30/2022] Open
Abstract
Postcontrast computed tomographic (CT) characteristics of gastrointestinal (GI) wall edema in humans have been described as GI wall thickening with a thickened submucosal layer and thin enhanced inner and outer layers. Published studies describing CT features of gastric wall edema in dogs are currently lacking. The aim of this retrospective, case series was to describe CT features of gastric wall edema in a group of dogs. Medical records were searched for dogs with postcontrast abdominal CT scans and a diagnosis of gastric wall edema based on histopathology (group I) or CT characteristics consistent with those reported in humans (group II). Clinical diagnosis, mean serum albumin concentration, and histopathological diagnosis were recorded. The following CT characteristics were recorded: numbers of wall layers, attenuation and contrast enhancement, presence of blood vessels, locations, distribution, and thickness. Twelve dogs (3 in group I and 9 in group II) were included. The most common clinical finding was hypoalbuminemia. In group I, a well-defined three-layer appearance with a non-enhancing fluid-attenuating middle layer was observed in three dogs and thin blood vessels in the middle layer in two dogs. In group II, nine dogs had a three-layer appearance with a non-enhancing fluid-attenuating middle layer. Locations of gastric wall thickening were diffuse in two, focal concentric in six, and focal asymmetric in four dogs. Findings supported including gastric wall edema as a differential diagnosis for dogs with hypoalbuminemia and CT characteristics of a three-layer appearance in the gastric wall, with a non-enhancing fluid-attenuating middle layer and thin blood vessels.
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Affiliation(s)
- Masahiro Murakami
- Department of Veterinary Clinical SciencesCollege of Veterinary Medicine, Purdue UniversityWest LafayetteIndianaUSA
| | - Hock Gan Heng
- Department of Veterinary Clinical SciencesCollege of Veterinary Medicine, Purdue UniversityWest LafayetteIndianaUSA
| | - Mario Sola
- Department of Comparative PathobiologyCollege of Veterinary Medicine, Purdue UniversityWest LafayetteIndianaUSA
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Ackman JB, Chintanapakdee W, Mendoza DP, Price MC, Lanuti M, Shepard JAO. Longitudinal CT and MRI Characteristics of Unilocular Thymic Cysts. Radiology 2021; 301:443-454. [PMID: 34427460 DOI: 10.1148/radiol.2021203593] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Isoattenuating and hyperattenuating thymic cysts at CT are often misinterpreted as lymphadenopathy or thymic epithelial neoplasms. Purpose To evaluate the longitudinal change in thymic cyst appearance at CT and MRI. Materials and Methods All chest MRI studies showing thymic cysts between July 2008 and December 2019, identified from a retrospective search of a quality assurance database, were included in this study if initial CT depicted a thymic lesion, the patient was referred for follow-up MRI for characterization, and the baseline (ie, index) MRI indicated a cystic lesion. Follow-up CT scans and/or MRI scans were identified through July 2020. Thymic cyst characteristics, such as size, location, and morphologic features, as well as CT and MRI characteristics, were recorded. Change in size, attenuation, and T1-weighted MRI signal was assessed longitudinally. Descriptive statistics of longitudinal change were tabulated. Results A total of 244 chest MRI studies in 140 patients with 142 unique cysts and 392 CT examinations (636 total examinations and 645 thymic cysts-nine examinations with two cysts each) were evaluated. The median follow-up duration was 2.2 years. Thirty-three patients with 34 unique cysts (34 of 142 cysts [24%]) underwent imaging follow-up for more than 5 years. Thymic cysts followed up for more than 5 years were most commonly saccular (189 of 274 cysts [69% axially]) and retrosternal (14 of 34 cysts [41%]). Craniocaudal dimension was larger than transverse and anteroposterior dimensions in 223 of 274 cysts (81%). Mean thymic cyst attenuation was 25 HU (range, 15-100 HU). Five of 31 cysts (16%) exhibited wall calcification. The median cyst wall thickness was 2.0 mm (range, 0.9-3.0 mm). Most thymic cysts changed in volume (31 of 34 cysts [91%]), CT attenuation (15 of 35 cysts [43%]), and T1-weighted MRI signal (12 of 18 cysts [67%]) over time. None developed mural irregularity, nodularity, or septations. Conclusion Unilocular thymic cysts, defined at index MRI, never developed irregular wall thickening, mural nodularity, or septations that would raise concern for malignant transformation. However, these cysts showed mural calcification and change in size, CT attenuation, and MRI signal over more than 5 years of follow-up. © RSNA, 2021 Online supplemental material is available for this article.
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Affiliation(s)
- Jeanne B Ackman
- From the Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Founders House 202, Boston, MA 02114
| | - Wariya Chintanapakdee
- From the Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Founders House 202, Boston, MA 02114
| | - Dexter P Mendoza
- From the Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Founders House 202, Boston, MA 02114
| | - Melissa C Price
- From the Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Founders House 202, Boston, MA 02114
| | - Michael Lanuti
- From the Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Founders House 202, Boston, MA 02114
| | - Jo-Anne O Shepard
- From the Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Founders House 202, Boston, MA 02114
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Stratification of cystic renal masses into benign and potentially malignant: applying machine learning to the bosniak classification. Abdom Radiol (NY) 2021; 46:311-318. [PMID: 32613401 DOI: 10.1007/s00261-020-02629-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/14/2020] [Accepted: 06/23/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE To create a CT texture-based machine learning algorithm that distinguishes benign from potentially malignant cystic renal masses as defined by the Bosniak Classification version 2019. METHODS In this IRB-approved, HIPAA-compliant study, 4,454 adult patients underwent renal mass protocol CT or CT urography from January 2011 to June 2018. Of these, 257 cystic renal masses were included in the final study cohort. Each mass was independently classified using Bosniak version 2019 by three radiologists, resulting in 185 benign (Bosniak I or II) and 72 potentially malignant (Bosniak IIF, III or IV) masses. Six texture features: mean, standard deviation, mean of positive pixels, entropy, skewness, kurtosis were extracted using commercial software TexRAD (Feedback PLC, Cambridge, UK). Random forest (RF), logistic regression (LR), and support vector machine (SVM) machine learning algorithms were implemented to classify cystic renal masses into the two groups and tested with tenfold cross validations. RESULTS Higher mean, standard deviation, mean of positive pixels, entropy, skewness were statistically associated with the potentially malignant group (P ≤ 0.0015 each). Sensitivity, specificity, positive predictive value, negative predictive value, and area under curve of RF model was 0.67, 0.91, 0.75, 0.88, 0.88; of LR model was 0.63, 0.93, 0.78, 0.86, 0.90, and of SVM model was 0.56, 0.91, 0.71, 0.84, 0.89, respectively. CONCLUSION Three CT texture-based machine learning algorithms demonstrated high discriminatory capability in distinguishing benign from potentially malignant cystic renal masses as defined by the Bosniak Classification version 2019. If validated, CT texture-based machine learning algorithms may help reduce interreader variability when applying the Bosniak classification.
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10
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Sefik E, Bozkurt IH, Oguzdogan GY, Çelik S, Basmaci I, Gorgel SN, Aydin E, Adibelli ZH, Vardar E, Gunlusoy B, Degirmenci T. Predictive Value of Additional Clinical and Radiological Parameters for Discrimination of Malignancy in Bosniak 3 Cysts. Urol Int 2020; 105:118-123. [PMID: 33242872 DOI: 10.1159/000510243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/16/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Almost half of the cystic renal lesions are still overdiagnosed and overtreated. New clinical and radiological parameters are needed to distinguish the malignant Bosniak 3 lesions from the benign ones. We aimed to evaluate the clinical and radiological parameters that may be related to malignancy risk for Bosniak category 3 renal cysts. MATERIALS AND METHODS Patients who underwent surgical resection of a histopathologically confirmed Bosniak 3 renal cyst between March 2007 and September 2019 were evaluated. Two experienced uro-radiologists have reevaluated the last preoperative computed tomography and/or MRI images of the patients and reclassified the lesions according to the Bosniak classification. They also reported cystic features such as nodularity, septation, focal thickening, enhancement, and calcification. Clinical, pathological, and oncological outcomes were recorded. Then patients were divided into 2 groups as Group 1 (benign pathology) and Group 2 (malignant pathology) according to final histopathological report. RESULTS A total of 79 patients were included in this study. Mean follow-up time was 47 ± 34 months. There were 30 patients in Group 1 and 49 patients in Group 2. Hypertension (p = 0.001) and smoking history (p = 0.008) were more common in malignant group. Among the radiological findings, lower tumor diameter (p = 0.024), presence of cyst wall enhancement (p = 0.025), presence of nodularity (p = 0.002), and presence of focal thickening (p = 0.031) were found to be statistically significant for malignancy. Most of the tumors were at pathological T1 stage and Fuhrmann Grade 1-2. Only nodularity was found to be independent predictive factor for malignancy in multivariate analysis. CONCLUSION Clinical factors including hypertension and smoking, radiological factors including lower lesion size, cyst wall enhancement, nodularity, and focal thickening were predictors for malignancy of Bosniak 3 cysts.
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Affiliation(s)
- Ertugrul Sefik
- Department of Urology, Health Sciences University, Bozyaka Training and Research Hospital, Izmir, Turkey,
| | - Ibrahim Halil Bozkurt
- Department of Urology, Health Sciences University, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Gulsen Yucel Oguzdogan
- Department of Radiology, Health Sciences University, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Serdar Çelik
- Department of Urology, Health Sciences University, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Ismail Basmaci
- Department of Urology, Health Sciences University, Bozyaka Training and Research Hospital, Izmir, Turkey
| | | | - Erhan Aydin
- Department of Urology, Health Sciences University, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Zehra Hilal Adibelli
- Department of Radiology, Health Sciences University, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Enver Vardar
- Department of Pathology, Bozyaka Training and Research Hospital, Health Sciences University, Izmir, Turkey
| | - Bulent Gunlusoy
- Department of Urology, Health Sciences University, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Tansu Degirmenci
- Department of Urology, Health Sciences University, Bozyaka Training and Research Hospital, Izmir, Turkey
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Bai X, Sun SM, Xu W, Kang HH, Li L, Jin YQ, Gong QGL, Liang GC, Liu HY, Liu LL, Chen SL, Wang QR, Wu P, Guo AT, Huang QB, Zhang XJ, Ye HY, Wang HY. MRI-based Bosniak Classification of Cystic Renal Masses, Version 2019: Interobserver Agreement, Impact of Readers' Experience, and Diagnostic Performance. Radiology 2020; 297:597-605. [PMID: 32960726 DOI: 10.1148/radiol.2020200478] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background The 2019 Bosniak classification (version 2019) of cystic renal masses (CRMs) provides a systematic update to the currently used 2005 Bosniak classification (version 2005). Further validation is required before widespread application. Purpose To evaluate the interobserver agreement of MRI criteria, the impact of readers' experience, and the diagnostic performance between version 2019 and version 2005. Materials and Methods From January 2009 to December 2018, consecutive patients with CRM who had undergone renal MRI and surgical-pathologic examination were included in this retrospective study. On the basis of version 2019 and version 2005, all CRMs were independently classified by eight radiologists with different levels of experience. By using multirater κ statistics, interobserver agreement was evaluated with comparisons between classifications and between senior and junior radiologists. Diagnostic performance between classifications by dichotomizing classes I-IV into lower (I-IIF) and higher (III-IV) classes was compared by using the McNemar test. P < .05 was considered to indicate a statistically significant difference. Results A total of 207 patients (mean age ± standard deviation, 49 years ± 12; 139 male and 68 female patients) with CRMs were included. Overall, interobserver agreement was higher with version 2019 than version 2005 (weighted κ = 0.64 vs 0.50, respectively; P < .001). Interobserver agreement between senior and junior radiologists did not differ between version 2019 (weighted κ = 0.65 vs 0.64, respectively; P = .71) and version 2005 (weighted κ = 0.54 vs 0.46; P < .001). Diagnostic specificity for malignancy was higher with version 2019 than with version 2005 (83% [92 of 111] vs 68% [75 of 111], respectively; P < .001), without any difference in sensitivity (89% [85 of 96] vs 84% [81 of 96]; P = .34). Conclusion In the updated Bosniak classification, interobserver agreement improved and was unaffected by observers' experience. The diagnostic performance with version 2019 was superior to that with version 2005, with higher specificity. Published under a CC BY 4.0 license. Online supplemental material is available for this article. See also the editorial by Choyke in this issue.
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Affiliation(s)
- Xu Bai
- From the Medical School of Chinese PLA, No. 28 Fuxing Rd, Haidian District, Beijing 100853, China (X.B., S.M.S., H.H.K.); Department of Radiology, First Medical Center, Chinese PLA General Hospital, Beijing, China (X.B., W.X., H.H.K., X.J.Z., H.Y.Y., H.Y.W.); Department of Health Service, Second Medical Center, Chinese PLA General Hospital, Beijing, China (S.M.S.); Department of Medical Statistic, Institute for Hospital Management Research, Chinese PLA General Hospital, Beijing, China (L.L.); Department of Radiology, Huaiyang County People's Hospital, Zhoukou, China (Y.Q.J.); Department of Radiology, Armed Police Corps Hospital of Henan Province, Zhengzhou, China (Q.G.L.G.); Department of Radiology, Zunhua Second Hospital, Zunhua, China (G.C.L.); Department of Radiology, Baoding Qingyuan District People's Hospital, Baoding, China (H.Y.L.); Department of Radiology, Beijing First Hospital of Integrated Chinese and Western Medicine, Beijing, China (L.L.L.); Department of Radiology, Seventh Medical Center, Chinese PLA General Hospital, Beijing, China (S.L.C.); Department of Radiology, The People's Hospital of Xishuangbanna Dai Nationality Autonomous Prefecture, Jinghong, China (Q.R.W.); Department of Radiology, First Affiliated Hospital of Hebei North University, Zhangjiakou, China (P.W.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (A.T.G.). Department of Urology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Q.B.H.)
| | - Song-Mei Sun
- From the Medical School of Chinese PLA, No. 28 Fuxing Rd, Haidian District, Beijing 100853, China (X.B., S.M.S., H.H.K.); Department of Radiology, First Medical Center, Chinese PLA General Hospital, Beijing, China (X.B., W.X., H.H.K., X.J.Z., H.Y.Y., H.Y.W.); Department of Health Service, Second Medical Center, Chinese PLA General Hospital, Beijing, China (S.M.S.); Department of Medical Statistic, Institute for Hospital Management Research, Chinese PLA General Hospital, Beijing, China (L.L.); Department of Radiology, Huaiyang County People's Hospital, Zhoukou, China (Y.Q.J.); Department of Radiology, Armed Police Corps Hospital of Henan Province, Zhengzhou, China (Q.G.L.G.); Department of Radiology, Zunhua Second Hospital, Zunhua, China (G.C.L.); Department of Radiology, Baoding Qingyuan District People's Hospital, Baoding, China (H.Y.L.); Department of Radiology, Beijing First Hospital of Integrated Chinese and Western Medicine, Beijing, China (L.L.L.); Department of Radiology, Seventh Medical Center, Chinese PLA General Hospital, Beijing, China (S.L.C.); Department of Radiology, The People's Hospital of Xishuangbanna Dai Nationality Autonomous Prefecture, Jinghong, China (Q.R.W.); Department of Radiology, First Affiliated Hospital of Hebei North University, Zhangjiakou, China (P.W.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (A.T.G.). Department of Urology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Q.B.H.)
| | - Wei Xu
- From the Medical School of Chinese PLA, No. 28 Fuxing Rd, Haidian District, Beijing 100853, China (X.B., S.M.S., H.H.K.); Department of Radiology, First Medical Center, Chinese PLA General Hospital, Beijing, China (X.B., W.X., H.H.K., X.J.Z., H.Y.Y., H.Y.W.); Department of Health Service, Second Medical Center, Chinese PLA General Hospital, Beijing, China (S.M.S.); Department of Medical Statistic, Institute for Hospital Management Research, Chinese PLA General Hospital, Beijing, China (L.L.); Department of Radiology, Huaiyang County People's Hospital, Zhoukou, China (Y.Q.J.); Department of Radiology, Armed Police Corps Hospital of Henan Province, Zhengzhou, China (Q.G.L.G.); Department of Radiology, Zunhua Second Hospital, Zunhua, China (G.C.L.); Department of Radiology, Baoding Qingyuan District People's Hospital, Baoding, China (H.Y.L.); Department of Radiology, Beijing First Hospital of Integrated Chinese and Western Medicine, Beijing, China (L.L.L.); Department of Radiology, Seventh Medical Center, Chinese PLA General Hospital, Beijing, China (S.L.C.); Department of Radiology, The People's Hospital of Xishuangbanna Dai Nationality Autonomous Prefecture, Jinghong, China (Q.R.W.); Department of Radiology, First Affiliated Hospital of Hebei North University, Zhangjiakou, China (P.W.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (A.T.G.). Department of Urology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Q.B.H.)
| | - Huan-Huan Kang
- From the Medical School of Chinese PLA, No. 28 Fuxing Rd, Haidian District, Beijing 100853, China (X.B., S.M.S., H.H.K.); Department of Radiology, First Medical Center, Chinese PLA General Hospital, Beijing, China (X.B., W.X., H.H.K., X.J.Z., H.Y.Y., H.Y.W.); Department of Health Service, Second Medical Center, Chinese PLA General Hospital, Beijing, China (S.M.S.); Department of Medical Statistic, Institute for Hospital Management Research, Chinese PLA General Hospital, Beijing, China (L.L.); Department of Radiology, Huaiyang County People's Hospital, Zhoukou, China (Y.Q.J.); Department of Radiology, Armed Police Corps Hospital of Henan Province, Zhengzhou, China (Q.G.L.G.); Department of Radiology, Zunhua Second Hospital, Zunhua, China (G.C.L.); Department of Radiology, Baoding Qingyuan District People's Hospital, Baoding, China (H.Y.L.); Department of Radiology, Beijing First Hospital of Integrated Chinese and Western Medicine, Beijing, China (L.L.L.); Department of Radiology, Seventh Medical Center, Chinese PLA General Hospital, Beijing, China (S.L.C.); Department of Radiology, The People's Hospital of Xishuangbanna Dai Nationality Autonomous Prefecture, Jinghong, China (Q.R.W.); Department of Radiology, First Affiliated Hospital of Hebei North University, Zhangjiakou, China (P.W.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (A.T.G.). Department of Urology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Q.B.H.)
| | - Lin Li
- From the Medical School of Chinese PLA, No. 28 Fuxing Rd, Haidian District, Beijing 100853, China (X.B., S.M.S., H.H.K.); Department of Radiology, First Medical Center, Chinese PLA General Hospital, Beijing, China (X.B., W.X., H.H.K., X.J.Z., H.Y.Y., H.Y.W.); Department of Health Service, Second Medical Center, Chinese PLA General Hospital, Beijing, China (S.M.S.); Department of Medical Statistic, Institute for Hospital Management Research, Chinese PLA General Hospital, Beijing, China (L.L.); Department of Radiology, Huaiyang County People's Hospital, Zhoukou, China (Y.Q.J.); Department of Radiology, Armed Police Corps Hospital of Henan Province, Zhengzhou, China (Q.G.L.G.); Department of Radiology, Zunhua Second Hospital, Zunhua, China (G.C.L.); Department of Radiology, Baoding Qingyuan District People's Hospital, Baoding, China (H.Y.L.); Department of Radiology, Beijing First Hospital of Integrated Chinese and Western Medicine, Beijing, China (L.L.L.); Department of Radiology, Seventh Medical Center, Chinese PLA General Hospital, Beijing, China (S.L.C.); Department of Radiology, The People's Hospital of Xishuangbanna Dai Nationality Autonomous Prefecture, Jinghong, China (Q.R.W.); Department of Radiology, First Affiliated Hospital of Hebei North University, Zhangjiakou, China (P.W.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (A.T.G.). Department of Urology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Q.B.H.)
| | - Ye-Qiang Jin
- From the Medical School of Chinese PLA, No. 28 Fuxing Rd, Haidian District, Beijing 100853, China (X.B., S.M.S., H.H.K.); Department of Radiology, First Medical Center, Chinese PLA General Hospital, Beijing, China (X.B., W.X., H.H.K., X.J.Z., H.Y.Y., H.Y.W.); Department of Health Service, Second Medical Center, Chinese PLA General Hospital, Beijing, China (S.M.S.); Department of Medical Statistic, Institute for Hospital Management Research, Chinese PLA General Hospital, Beijing, China (L.L.); Department of Radiology, Huaiyang County People's Hospital, Zhoukou, China (Y.Q.J.); Department of Radiology, Armed Police Corps Hospital of Henan Province, Zhengzhou, China (Q.G.L.G.); Department of Radiology, Zunhua Second Hospital, Zunhua, China (G.C.L.); Department of Radiology, Baoding Qingyuan District People's Hospital, Baoding, China (H.Y.L.); Department of Radiology, Beijing First Hospital of Integrated Chinese and Western Medicine, Beijing, China (L.L.L.); Department of Radiology, Seventh Medical Center, Chinese PLA General Hospital, Beijing, China (S.L.C.); Department of Radiology, The People's Hospital of Xishuangbanna Dai Nationality Autonomous Prefecture, Jinghong, China (Q.R.W.); Department of Radiology, First Affiliated Hospital of Hebei North University, Zhangjiakou, China (P.W.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (A.T.G.). Department of Urology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Q.B.H.)
| | - Qing-Ge-Le Gong
- From the Medical School of Chinese PLA, No. 28 Fuxing Rd, Haidian District, Beijing 100853, China (X.B., S.M.S., H.H.K.); Department of Radiology, First Medical Center, Chinese PLA General Hospital, Beijing, China (X.B., W.X., H.H.K., X.J.Z., H.Y.Y., H.Y.W.); Department of Health Service, Second Medical Center, Chinese PLA General Hospital, Beijing, China (S.M.S.); Department of Medical Statistic, Institute for Hospital Management Research, Chinese PLA General Hospital, Beijing, China (L.L.); Department of Radiology, Huaiyang County People's Hospital, Zhoukou, China (Y.Q.J.); Department of Radiology, Armed Police Corps Hospital of Henan Province, Zhengzhou, China (Q.G.L.G.); Department of Radiology, Zunhua Second Hospital, Zunhua, China (G.C.L.); Department of Radiology, Baoding Qingyuan District People's Hospital, Baoding, China (H.Y.L.); Department of Radiology, Beijing First Hospital of Integrated Chinese and Western Medicine, Beijing, China (L.L.L.); Department of Radiology, Seventh Medical Center, Chinese PLA General Hospital, Beijing, China (S.L.C.); Department of Radiology, The People's Hospital of Xishuangbanna Dai Nationality Autonomous Prefecture, Jinghong, China (Q.R.W.); Department of Radiology, First Affiliated Hospital of Hebei North University, Zhangjiakou, China (P.W.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (A.T.G.). Department of Urology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Q.B.H.)
| | - Guo-Cheng Liang
- From the Medical School of Chinese PLA, No. 28 Fuxing Rd, Haidian District, Beijing 100853, China (X.B., S.M.S., H.H.K.); Department of Radiology, First Medical Center, Chinese PLA General Hospital, Beijing, China (X.B., W.X., H.H.K., X.J.Z., H.Y.Y., H.Y.W.); Department of Health Service, Second Medical Center, Chinese PLA General Hospital, Beijing, China (S.M.S.); Department of Medical Statistic, Institute for Hospital Management Research, Chinese PLA General Hospital, Beijing, China (L.L.); Department of Radiology, Huaiyang County People's Hospital, Zhoukou, China (Y.Q.J.); Department of Radiology, Armed Police Corps Hospital of Henan Province, Zhengzhou, China (Q.G.L.G.); Department of Radiology, Zunhua Second Hospital, Zunhua, China (G.C.L.); Department of Radiology, Baoding Qingyuan District People's Hospital, Baoding, China (H.Y.L.); Department of Radiology, Beijing First Hospital of Integrated Chinese and Western Medicine, Beijing, China (L.L.L.); Department of Radiology, Seventh Medical Center, Chinese PLA General Hospital, Beijing, China (S.L.C.); Department of Radiology, The People's Hospital of Xishuangbanna Dai Nationality Autonomous Prefecture, Jinghong, China (Q.R.W.); Department of Radiology, First Affiliated Hospital of Hebei North University, Zhangjiakou, China (P.W.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (A.T.G.). Department of Urology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Q.B.H.)
| | - Hong-Yan Liu
- From the Medical School of Chinese PLA, No. 28 Fuxing Rd, Haidian District, Beijing 100853, China (X.B., S.M.S., H.H.K.); Department of Radiology, First Medical Center, Chinese PLA General Hospital, Beijing, China (X.B., W.X., H.H.K., X.J.Z., H.Y.Y., H.Y.W.); Department of Health Service, Second Medical Center, Chinese PLA General Hospital, Beijing, China (S.M.S.); Department of Medical Statistic, Institute for Hospital Management Research, Chinese PLA General Hospital, Beijing, China (L.L.); Department of Radiology, Huaiyang County People's Hospital, Zhoukou, China (Y.Q.J.); Department of Radiology, Armed Police Corps Hospital of Henan Province, Zhengzhou, China (Q.G.L.G.); Department of Radiology, Zunhua Second Hospital, Zunhua, China (G.C.L.); Department of Radiology, Baoding Qingyuan District People's Hospital, Baoding, China (H.Y.L.); Department of Radiology, Beijing First Hospital of Integrated Chinese and Western Medicine, Beijing, China (L.L.L.); Department of Radiology, Seventh Medical Center, Chinese PLA General Hospital, Beijing, China (S.L.C.); Department of Radiology, The People's Hospital of Xishuangbanna Dai Nationality Autonomous Prefecture, Jinghong, China (Q.R.W.); Department of Radiology, First Affiliated Hospital of Hebei North University, Zhangjiakou, China (P.W.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (A.T.G.). Department of Urology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Q.B.H.)
| | - Lin-Lin Liu
- From the Medical School of Chinese PLA, No. 28 Fuxing Rd, Haidian District, Beijing 100853, China (X.B., S.M.S., H.H.K.); Department of Radiology, First Medical Center, Chinese PLA General Hospital, Beijing, China (X.B., W.X., H.H.K., X.J.Z., H.Y.Y., H.Y.W.); Department of Health Service, Second Medical Center, Chinese PLA General Hospital, Beijing, China (S.M.S.); Department of Medical Statistic, Institute for Hospital Management Research, Chinese PLA General Hospital, Beijing, China (L.L.); Department of Radiology, Huaiyang County People's Hospital, Zhoukou, China (Y.Q.J.); Department of Radiology, Armed Police Corps Hospital of Henan Province, Zhengzhou, China (Q.G.L.G.); Department of Radiology, Zunhua Second Hospital, Zunhua, China (G.C.L.); Department of Radiology, Baoding Qingyuan District People's Hospital, Baoding, China (H.Y.L.); Department of Radiology, Beijing First Hospital of Integrated Chinese and Western Medicine, Beijing, China (L.L.L.); Department of Radiology, Seventh Medical Center, Chinese PLA General Hospital, Beijing, China (S.L.C.); Department of Radiology, The People's Hospital of Xishuangbanna Dai Nationality Autonomous Prefecture, Jinghong, China (Q.R.W.); Department of Radiology, First Affiliated Hospital of Hebei North University, Zhangjiakou, China (P.W.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (A.T.G.). Department of Urology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Q.B.H.)
| | - Si-Lu Chen
- From the Medical School of Chinese PLA, No. 28 Fuxing Rd, Haidian District, Beijing 100853, China (X.B., S.M.S., H.H.K.); Department of Radiology, First Medical Center, Chinese PLA General Hospital, Beijing, China (X.B., W.X., H.H.K., X.J.Z., H.Y.Y., H.Y.W.); Department of Health Service, Second Medical Center, Chinese PLA General Hospital, Beijing, China (S.M.S.); Department of Medical Statistic, Institute for Hospital Management Research, Chinese PLA General Hospital, Beijing, China (L.L.); Department of Radiology, Huaiyang County People's Hospital, Zhoukou, China (Y.Q.J.); Department of Radiology, Armed Police Corps Hospital of Henan Province, Zhengzhou, China (Q.G.L.G.); Department of Radiology, Zunhua Second Hospital, Zunhua, China (G.C.L.); Department of Radiology, Baoding Qingyuan District People's Hospital, Baoding, China (H.Y.L.); Department of Radiology, Beijing First Hospital of Integrated Chinese and Western Medicine, Beijing, China (L.L.L.); Department of Radiology, Seventh Medical Center, Chinese PLA General Hospital, Beijing, China (S.L.C.); Department of Radiology, The People's Hospital of Xishuangbanna Dai Nationality Autonomous Prefecture, Jinghong, China (Q.R.W.); Department of Radiology, First Affiliated Hospital of Hebei North University, Zhangjiakou, China (P.W.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (A.T.G.). Department of Urology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Q.B.H.)
| | - Qing-Rong Wang
- From the Medical School of Chinese PLA, No. 28 Fuxing Rd, Haidian District, Beijing 100853, China (X.B., S.M.S., H.H.K.); Department of Radiology, First Medical Center, Chinese PLA General Hospital, Beijing, China (X.B., W.X., H.H.K., X.J.Z., H.Y.Y., H.Y.W.); Department of Health Service, Second Medical Center, Chinese PLA General Hospital, Beijing, China (S.M.S.); Department of Medical Statistic, Institute for Hospital Management Research, Chinese PLA General Hospital, Beijing, China (L.L.); Department of Radiology, Huaiyang County People's Hospital, Zhoukou, China (Y.Q.J.); Department of Radiology, Armed Police Corps Hospital of Henan Province, Zhengzhou, China (Q.G.L.G.); Department of Radiology, Zunhua Second Hospital, Zunhua, China (G.C.L.); Department of Radiology, Baoding Qingyuan District People's Hospital, Baoding, China (H.Y.L.); Department of Radiology, Beijing First Hospital of Integrated Chinese and Western Medicine, Beijing, China (L.L.L.); Department of Radiology, Seventh Medical Center, Chinese PLA General Hospital, Beijing, China (S.L.C.); Department of Radiology, The People's Hospital of Xishuangbanna Dai Nationality Autonomous Prefecture, Jinghong, China (Q.R.W.); Department of Radiology, First Affiliated Hospital of Hebei North University, Zhangjiakou, China (P.W.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (A.T.G.). Department of Urology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Q.B.H.)
| | - Peng Wu
- From the Medical School of Chinese PLA, No. 28 Fuxing Rd, Haidian District, Beijing 100853, China (X.B., S.M.S., H.H.K.); Department of Radiology, First Medical Center, Chinese PLA General Hospital, Beijing, China (X.B., W.X., H.H.K., X.J.Z., H.Y.Y., H.Y.W.); Department of Health Service, Second Medical Center, Chinese PLA General Hospital, Beijing, China (S.M.S.); Department of Medical Statistic, Institute for Hospital Management Research, Chinese PLA General Hospital, Beijing, China (L.L.); Department of Radiology, Huaiyang County People's Hospital, Zhoukou, China (Y.Q.J.); Department of Radiology, Armed Police Corps Hospital of Henan Province, Zhengzhou, China (Q.G.L.G.); Department of Radiology, Zunhua Second Hospital, Zunhua, China (G.C.L.); Department of Radiology, Baoding Qingyuan District People's Hospital, Baoding, China (H.Y.L.); Department of Radiology, Beijing First Hospital of Integrated Chinese and Western Medicine, Beijing, China (L.L.L.); Department of Radiology, Seventh Medical Center, Chinese PLA General Hospital, Beijing, China (S.L.C.); Department of Radiology, The People's Hospital of Xishuangbanna Dai Nationality Autonomous Prefecture, Jinghong, China (Q.R.W.); Department of Radiology, First Affiliated Hospital of Hebei North University, Zhangjiakou, China (P.W.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (A.T.G.). Department of Urology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Q.B.H.)
| | - Ai-Tao Guo
- From the Medical School of Chinese PLA, No. 28 Fuxing Rd, Haidian District, Beijing 100853, China (X.B., S.M.S., H.H.K.); Department of Radiology, First Medical Center, Chinese PLA General Hospital, Beijing, China (X.B., W.X., H.H.K., X.J.Z., H.Y.Y., H.Y.W.); Department of Health Service, Second Medical Center, Chinese PLA General Hospital, Beijing, China (S.M.S.); Department of Medical Statistic, Institute for Hospital Management Research, Chinese PLA General Hospital, Beijing, China (L.L.); Department of Radiology, Huaiyang County People's Hospital, Zhoukou, China (Y.Q.J.); Department of Radiology, Armed Police Corps Hospital of Henan Province, Zhengzhou, China (Q.G.L.G.); Department of Radiology, Zunhua Second Hospital, Zunhua, China (G.C.L.); Department of Radiology, Baoding Qingyuan District People's Hospital, Baoding, China (H.Y.L.); Department of Radiology, Beijing First Hospital of Integrated Chinese and Western Medicine, Beijing, China (L.L.L.); Department of Radiology, Seventh Medical Center, Chinese PLA General Hospital, Beijing, China (S.L.C.); Department of Radiology, The People's Hospital of Xishuangbanna Dai Nationality Autonomous Prefecture, Jinghong, China (Q.R.W.); Department of Radiology, First Affiliated Hospital of Hebei North University, Zhangjiakou, China (P.W.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (A.T.G.). Department of Urology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Q.B.H.)
| | - Qing-Bo Huang
- From the Medical School of Chinese PLA, No. 28 Fuxing Rd, Haidian District, Beijing 100853, China (X.B., S.M.S., H.H.K.); Department of Radiology, First Medical Center, Chinese PLA General Hospital, Beijing, China (X.B., W.X., H.H.K., X.J.Z., H.Y.Y., H.Y.W.); Department of Health Service, Second Medical Center, Chinese PLA General Hospital, Beijing, China (S.M.S.); Department of Medical Statistic, Institute for Hospital Management Research, Chinese PLA General Hospital, Beijing, China (L.L.); Department of Radiology, Huaiyang County People's Hospital, Zhoukou, China (Y.Q.J.); Department of Radiology, Armed Police Corps Hospital of Henan Province, Zhengzhou, China (Q.G.L.G.); Department of Radiology, Zunhua Second Hospital, Zunhua, China (G.C.L.); Department of Radiology, Baoding Qingyuan District People's Hospital, Baoding, China (H.Y.L.); Department of Radiology, Beijing First Hospital of Integrated Chinese and Western Medicine, Beijing, China (L.L.L.); Department of Radiology, Seventh Medical Center, Chinese PLA General Hospital, Beijing, China (S.L.C.); Department of Radiology, The People's Hospital of Xishuangbanna Dai Nationality Autonomous Prefecture, Jinghong, China (Q.R.W.); Department of Radiology, First Affiliated Hospital of Hebei North University, Zhangjiakou, China (P.W.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (A.T.G.). Department of Urology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Q.B.H.)
| | - Xiao-Jing Zhang
- From the Medical School of Chinese PLA, No. 28 Fuxing Rd, Haidian District, Beijing 100853, China (X.B., S.M.S., H.H.K.); Department of Radiology, First Medical Center, Chinese PLA General Hospital, Beijing, China (X.B., W.X., H.H.K., X.J.Z., H.Y.Y., H.Y.W.); Department of Health Service, Second Medical Center, Chinese PLA General Hospital, Beijing, China (S.M.S.); Department of Medical Statistic, Institute for Hospital Management Research, Chinese PLA General Hospital, Beijing, China (L.L.); Department of Radiology, Huaiyang County People's Hospital, Zhoukou, China (Y.Q.J.); Department of Radiology, Armed Police Corps Hospital of Henan Province, Zhengzhou, China (Q.G.L.G.); Department of Radiology, Zunhua Second Hospital, Zunhua, China (G.C.L.); Department of Radiology, Baoding Qingyuan District People's Hospital, Baoding, China (H.Y.L.); Department of Radiology, Beijing First Hospital of Integrated Chinese and Western Medicine, Beijing, China (L.L.L.); Department of Radiology, Seventh Medical Center, Chinese PLA General Hospital, Beijing, China (S.L.C.); Department of Radiology, The People's Hospital of Xishuangbanna Dai Nationality Autonomous Prefecture, Jinghong, China (Q.R.W.); Department of Radiology, First Affiliated Hospital of Hebei North University, Zhangjiakou, China (P.W.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (A.T.G.). Department of Urology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Q.B.H.)
| | - Hui-Yi Ye
- From the Medical School of Chinese PLA, No. 28 Fuxing Rd, Haidian District, Beijing 100853, China (X.B., S.M.S., H.H.K.); Department of Radiology, First Medical Center, Chinese PLA General Hospital, Beijing, China (X.B., W.X., H.H.K., X.J.Z., H.Y.Y., H.Y.W.); Department of Health Service, Second Medical Center, Chinese PLA General Hospital, Beijing, China (S.M.S.); Department of Medical Statistic, Institute for Hospital Management Research, Chinese PLA General Hospital, Beijing, China (L.L.); Department of Radiology, Huaiyang County People's Hospital, Zhoukou, China (Y.Q.J.); Department of Radiology, Armed Police Corps Hospital of Henan Province, Zhengzhou, China (Q.G.L.G.); Department of Radiology, Zunhua Second Hospital, Zunhua, China (G.C.L.); Department of Radiology, Baoding Qingyuan District People's Hospital, Baoding, China (H.Y.L.); Department of Radiology, Beijing First Hospital of Integrated Chinese and Western Medicine, Beijing, China (L.L.L.); Department of Radiology, Seventh Medical Center, Chinese PLA General Hospital, Beijing, China (S.L.C.); Department of Radiology, The People's Hospital of Xishuangbanna Dai Nationality Autonomous Prefecture, Jinghong, China (Q.R.W.); Department of Radiology, First Affiliated Hospital of Hebei North University, Zhangjiakou, China (P.W.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (A.T.G.). Department of Urology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Q.B.H.)
| | - Hai-Yi Wang
- From the Medical School of Chinese PLA, No. 28 Fuxing Rd, Haidian District, Beijing 100853, China (X.B., S.M.S., H.H.K.); Department of Radiology, First Medical Center, Chinese PLA General Hospital, Beijing, China (X.B., W.X., H.H.K., X.J.Z., H.Y.Y., H.Y.W.); Department of Health Service, Second Medical Center, Chinese PLA General Hospital, Beijing, China (S.M.S.); Department of Medical Statistic, Institute for Hospital Management Research, Chinese PLA General Hospital, Beijing, China (L.L.); Department of Radiology, Huaiyang County People's Hospital, Zhoukou, China (Y.Q.J.); Department of Radiology, Armed Police Corps Hospital of Henan Province, Zhengzhou, China (Q.G.L.G.); Department of Radiology, Zunhua Second Hospital, Zunhua, China (G.C.L.); Department of Radiology, Baoding Qingyuan District People's Hospital, Baoding, China (H.Y.L.); Department of Radiology, Beijing First Hospital of Integrated Chinese and Western Medicine, Beijing, China (L.L.L.); Department of Radiology, Seventh Medical Center, Chinese PLA General Hospital, Beijing, China (S.L.C.); Department of Radiology, The People's Hospital of Xishuangbanna Dai Nationality Autonomous Prefecture, Jinghong, China (Q.R.W.); Department of Radiology, First Affiliated Hospital of Hebei North University, Zhangjiakou, China (P.W.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (A.T.G.). Department of Urology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Q.B.H.)
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12
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Pacheco EO, Torres US, Alves AMA, Bekhor D, D'Ippolito G. Bosniak classification of cystic renal masses version 2019 does not increase the interobserver agreement or the proportion of masses categorized into lower Bosniak classes for non-subspecialized readers on CT or MR. Eur J Radiol 2020; 131:109270. [PMID: 32947091 DOI: 10.1016/j.ejrad.2020.109270] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 08/31/2020] [Accepted: 09/04/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE In a condition so prevalent as renal cysts, classifications should display satisfactory reproducibility not only among subspecialized readers. We aimed to compare the interobserver agreement of the Bosniak classification version 2019 (BC19) and current Bosniak classification (CBC) for non-subspecialized readers on CT and MRI and to verify whether BC19 leads to a downgrade of renal cystic masses when compared to CBC. METHODS We evaluated 50 renal cystic masses in 47 patients on MR and CT (25 per method). Eighteen readers (nine third-year radiology residents and nine abdominal imaging fellows) assessed the images using BC19 and CBC with an eight-week interval. Kappa statistic was used to assess agreement. An average score of Bosniak categories across all raters evaluated if there was downgrading of lesions on BC19. RESULTS The highest values of Kappa were found for fellows on CBC-MR (κ = 0.51), and the lowest values were found for residents on CBC-MR and fellows on BC19-MR (both κ = 0.36). On CBC, interobserver agreement was moderate for MR and CT (κ = 0.42 and 0.43, respectively), whereas on BC19, it was fair (κ = 0.38 and 0.40, respectively). The best agreements were in categories I (κ = 0.49-0.69) and IV (κ = 0.45-0.51). The poorest agreements occurred at IIF (κ = 0.18 on BC19-CT). There was a moderate median increase from CBC to BC19 in terms of Bosniak categories for both methods (MR [Z=-2.058, p = 0.040] and CT [Z=-2.509, p = 0.012]). CONCLUSION BC19, when compared to CBC, did not improve interobserver agreement nor diminished the proportion of masses categorized into lower Bosniak classes among non-subspecialized readers.
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Affiliation(s)
- Eduardo Oliveira Pacheco
- Hospital Sao Paulo, Universidade Federal de Sao Paulo (UNIFESP) - R. Botucatu, 740 - Vila Clementino, São Paulo, SP, 04023-062, Brazil.
| | - Ulysses S Torres
- Hospital Sao Paulo, Universidade Federal de Sao Paulo (UNIFESP) - R. Botucatu, 740 - Vila Clementino, São Paulo, SP, 04023-062, Brazil; Grupo Fleury - R. Cincinato Braga, 282 - Bela Vista, São Paulo, SP, 01333-910 Brazil
| | - Aldo Maurici Araújo Alves
- Hospital Sao Paulo, Universidade Federal de Sao Paulo (UNIFESP) - R. Botucatu, 740 - Vila Clementino, São Paulo, SP, 04023-062, Brazil
| | - Daniel Bekhor
- Hospital Sao Paulo, Universidade Federal de Sao Paulo (UNIFESP) - R. Botucatu, 740 - Vila Clementino, São Paulo, SP, 04023-062, Brazil
| | - Giuseppe D'Ippolito
- Hospital Sao Paulo, Universidade Federal de Sao Paulo (UNIFESP) - R. Botucatu, 740 - Vila Clementino, São Paulo, SP, 04023-062, Brazil; Grupo Fleury - R. Cincinato Braga, 282 - Bela Vista, São Paulo, SP, 01333-910 Brazil
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13
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Withey SJ, Verma H, Prezzi D. Multimodality Assessment of Cystic Renal Masses. Semin Ultrasound CT MR 2020; 41:334-343. [DOI: 10.1053/j.sult.2020.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Abstract
OBJECTIVE. The purpose of this study was to determine how use of Bosniak classification version 2019 affects categorization and overall accuracy of MRI evaluation of cystic renal masses with tissue pathologic analysis as the reference standard. MATERIALS AND METHODS. MR images of 50 consecutively registered patients with tissue pathologic results from 2005 to 2019 were retrospectively reviewed by two abdominal radiologists. Each radiologist independently assigned a category based on the original and Bosniak classification version 2019 systems. Interreader agreements (kappa statistic) for both were calculated, and consensus reading was performed. Tissue pathologic analysis was used as the reference standard to determine whether a lesion was benign or renal cell carcinoma. RESULTS. Fifty-nine cystic renal masses were characterized as 38 renal cell carcinomas and 21 benign lesions on the basis of the results of tissue pathologic analysis. By consensus, according to the original Bosniak criteria, the renal masses were classified into three category I, five category II, four category IIF, 25 category III, and 22 category IV lesions. By consensus, according to the version 2019 criteria, the renal masses were classified into three category I, two category II, 12 category IIF, 18 category III, and 24 category IV lesions. Overall sensitivity and specificity for identifying renal cell carcinoma were 95% and 81%, respectively, with the original classification system and 100% and 86%, respectively, with version 2019. Weighted interreader agreement was moderate for both the original system (κ = 0.57) and version 2019 (κ = 0.55). CONCLUSION. Use of Bosniak classification version 2019 system improves sensitivity and specificity for malignancy among cystic renal masses characterized with MRI. Most lesions that changed categories were reclassified as Bosniak category IIF.
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15
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Agnello F, Albano D, Micci G, Di Buono G, Agrusa A, Salvaggio G, Pardo S, Sparacia G, Bartolotta TV, Midiri M, Lagalla R, Galia M. CT and MR imaging of cystic renal lesions. Insights Imaging 2020; 11:5. [PMID: 31900669 PMCID: PMC6942066 DOI: 10.1186/s13244-019-0826-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 12/05/2019] [Indexed: 01/28/2023] Open
Abstract
Cystic renal lesions are a common incidental finding on routinely imaging examinations. Although a benign simple cyst is usually easy to recognize, the same is not true for complex and multifocal cystic renal lesions, whose differential diagnosis includes both neoplastic and non-neoplastic conditions. In this review, we will show a series of cases in order to provide tips to identify benign cysts and differentiate them from malignant ones.
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Affiliation(s)
- Francesco Agnello
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy.
| | - Domenico Albano
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy.,Unità di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy
| | - Giuseppe Micci
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Giuseppe Di Buono
- Dipartimento di Discipline Chirurgiche Oncologiche e Stomatologiche, Università degli Studi di Palermo, Via Liborio Giuffrè 5, 90127, Palermo, Italy
| | - Antonino Agrusa
- Dipartimento di Discipline Chirurgiche Oncologiche e Stomatologiche, Università degli Studi di Palermo, Via Liborio Giuffrè 5, 90127, Palermo, Italy
| | - Giuseppe Salvaggio
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Salvatore Pardo
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Gianvincenzo Sparacia
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Tommaso Vincenzo Bartolotta
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy.,Dipartimento di Radiologia, Fondazione Istituto Giuseppe Giglio, Contrada Pietrapollastra, Via Picciotto, 90015, Cefalù (Palermo), Italy
| | - Massimo Midiri
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Roberto Lagalla
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Massimo Galia
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy
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Ye J, Xu Q, Zheng J, Wang SA, Wu YW, Cai JH, Yuan H. Imaging of mixed epithelial and stromal tumor of the kidney: A case report and review of the literature. World J Clin Cases 2019; 7:2580-2586. [PMID: 31559296 PMCID: PMC6745317 DOI: 10.12998/wjcc.v7.i17.2580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 07/11/2019] [Accepted: 07/27/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Mixed epithelial and stromal tumors of the kidney (MESTKs) are a rare entity (about a hundred cases reported). They occur almost exclusively in postmenopausal women, with only seven cases reported in men. As this entity is very rare, little is known on its imaging features, especially magnetic resonance imaging (MRI) findings. In women, at MRI, the cystic component shows T1 hypointensity and T2 hyperintensity, while the solid component shows T1 hyperintensity and T2 hypointensity.
CASE SUMMARY We report the computed tomography (CT) and MRI findings of MESTK in a 19-year-old male adolescent. To our knowledge, this case report is the first report of MRI findings of MESTK in male adolescents. The patient was admitted to Subei People's Hospital (Jiangsu Province, China) in July 2017 after a renal mass on the left side was detected by ultrasound during a clinical examination. Blood tests were all normal. Non-enhanced CT showed a round, well-circumscribed complex mass, approximately 45 mm × 40 mm in size. MRI revealed a clear well-circumscribed mass with a mixed arrangement of solid and cystic components. On T2 weighted images, some hypointensities were found in the solid areas. After contrast enhancement, moderate or mild enhancement was found in the solid component, which increased with time. A radical left nephrectomy was performed. The pathology analysis revealed a mixed epithelial and stromal tumor. The patient had no imaging findings of recurrence or metastasis at 12 months following surgery.
CONCLUSION The possibility of MESTK should be considered in male adolescents. MRI can provide useful information for the preoperative diagnosis.
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Affiliation(s)
- Jing Ye
- Department of Medical Imaging, Clinic Medical School, Yangzhou University, Northern Jiangsu Province Hospital, Yangzhou 225000, Jiangsu Province, China
| | - Qing Xu
- Department of Medical Imaging, Clinic Medical School, Yangzhou University, Northern Jiangsu Province Hospital, Yangzhou 225000, Jiangsu Province, China
| | - Jing Zheng
- Department of Medical Imaging, Clinic Medical School, Yangzhou University, Northern Jiangsu Province Hospital, Yangzhou 225000, Jiangsu Province, China
| | - Shou-An Wang
- Department of Medical Imaging, Clinic Medical School, Yangzhou University, Northern Jiangsu Province Hospital, Yangzhou 225000, Jiangsu Province, China
| | - Ya-Wei Wu
- Department of Medical Imaging, Clinic Medical School, Yangzhou University, Northern Jiangsu Province Hospital, Yangzhou 225000, Jiangsu Province, China
| | - Jun-Hui Cai
- Dalian Medical University, Dalian 116000, Liaoning Province, China
| | - Hu Yuan
- Dalian Medical University, Dalian 116000, Liaoning Province, China
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17
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Dual energy CT for evaluation of polycystic kidneys: a multi reader study of interpretation time and diagnostic confidence. Abdom Radiol (NY) 2018; 43:3418-3424. [PMID: 29926138 DOI: 10.1007/s00261-018-1674-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE To compare dual-energy CT (DECT) iodine overlay images with renal mass protocol CT in the evaluation of polycystic kidneys with respect to reading time, diagnostic confidence, and detection of renal lesions that are not definitively benign. METHODS Following IRB approval, portal venous phase dual-source DECT scans performed between September 2013 and February 2016 from 55 patients (mean age 67 ± 15 years, 31 male, 24 female) with polycystic kidneys (4 or more cysts) were included. For each patient, two image sets were created: (1) DECT post-processed iodine overlay images and (2) simulated renal mass protocol CT images (virtual noncontrast and mixed images). Two radiologists independently retrospectively reviewed both sets at separate time points, evaluating for the presence of lesions that were not definitively benign (enhancing lesions or Bosniak IIF cysts), as well as reading times and Likert scale diagnostic confidence ratings (scaled 1-5) for the presence of non-benign lesions. Reading times were compared with a t test, diagnostic confidence with a McNemar test, and lesion number detection with Cohen's kappa test. RESULTS Iodine overlay images were read faster (mean 55 ± 26 s) than renal mass protocol (mean 105 ± 51 s) (p < 0.001). Readers assigned the highest diagnostic confidence rating in 64% using iodine overlay series, compared to 17% using renal mass protocol (p < 0.0001). The proportion of patients with recorded lesions was not significantly different between methods (p = 0.62). CONCLUSIONS DECT improves lesion assessment in polycystic kidneys by decreasing reading times and increasing diagnostic confidence, without affecting lesion detection rates.
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18
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Development and prospective validation of a novel weighted quantitative scoring system aimed at predicting the pathological features of cystic renal masses. Eur Radiol 2018; 29:1809-1819. [PMID: 30311030 DOI: 10.1007/s00330-018-5722-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 07/15/2018] [Accepted: 08/15/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To develop and prospectively validate a novel weighted quantitative scoring system based on CT findings, namely, the renal cyst index (RCI), aimed at preoperatively predicting the pathological features of cystic renal masses (CRMs). METHODS The RCI was based on four critical features of CRMs: the cyst wall, septal, nodule, and cyst contents. These parameters were scored with 1, 2, or 3 points. Weight coefficients for these parameters were determined by the multivariable logistic regression. The odds ratio (OR) and 95% confidence interval (95% CI) were used to summarise the results. The RCI was defined as the sum of these four weight coefficients. Malignancy risk prediction models were built based on the retrospective evaluation of 441 patients. We also compared the prediction ability of the RCI with the Bosniak classification in the 441 patients and applied these novel models to 152 masses resected in our institution to prospectively validate the efficiency of the RCI. RESULTS The wall point (OR = 5.71 [95% CI = 1.734-18.808, p = 0.004, point = 2], OR = 12.665 [95% CI = 3.750-42.770, p < 0.001, point = 3]), septal point (OR = 3.325 [95% CI = 1.272-8.692, p = 0.014, point = 3]), nodule point (OR = 4.588 [95% CI = 1.429-14.729, p < 0.001, point = 2], OR = 17.032 [95% CI = 5.017-57.820, p = 0.010, point = 3]), content point (OR = 22.822 [95% CI = 1.041-495.995, p = 0.047, point = 2], OR = 2.723 [95% CI = 1.296-10.696, p = 0.015, point = 3]), and RCI (OR = 1.247 [95% CI = 1.197-1.299, p < 0.001]) were significantly associated with malignancy. Masses with an RCI < 6 were regarded as benign masses; masses with an RCI ≥ 10 were regarded as malignant masses. The malignancy risk of masses with an RCI > 6 but < 10 were determined by a nomogram. The prediction ability of the RCI was significantly superior to the Bosniak classification for Bosniak IIF and III masses (AUC: 0.912 vs. 0.753, p = 0.001). The RCI also accurately predicted the pathological features of 152 masses. CONCLUSION The RCI is a reliable quantitative scoring system in predicting the malignancy risk of CRMs, and it outperformed the Bosniak classification system in some ways. KEY POINTS • The renal cyst index (RCI) is a useful weighted quantitative classification system based on CT findings for diagnosing cystic renal masses. • The RCI outperforms the Bosniak classification system in some ways, especially for Bosniak IIF and III masses. • Masses with an RCI < 6 can be regarded as a simple cyst, while those with an RCI > 10 can be regarded as malignant masses.
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19
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Schoots IG, Zaccai K, Hunink MG, Verhagen PC. Bosniak Classification for Complex Renal Cysts Reevaluated: A Systematic Review. J Urol 2017; 198:12-21. [DOI: 10.1016/j.juro.2016.09.160] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Ivo G. Schoots
- Department of Radiology and Nuclear Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Keren Zaccai
- Department of Urology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Myriam G. Hunink
- Department of Radiology and Nuclear Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
- Harvard School of Public Health, Harvard University, Department of Health Policy and Management, Boston, Massachusetts
| | - Paul C.M.S. Verhagen
- Department of Urology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
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20
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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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21
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Edenberg J, Gløersen K, Osman HA, Dimmen M, Berg GV. The role of contrast-enhanced ultrasound in the classification of CT-indeterminate renal lesions. Scand J Urol 2016; 50:445-451. [PMID: 27609413 DOI: 10.1080/21681805.2016.1221853] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Focal renal lesions are common incidental findings on computed tomography (CT). For lesions with a cystic appearance, the Bosniak classification system has enabled an important separation of benign and (potentially) malignant cysts, giving a practical guide for management. The purpose of this study was to evaluate contrast-enhanced ultrasound (CEUS) as a problem-solving modality for classification of indeterminate renal lesions detected with CT. MATERIALS AND METHODS In total, 140 consecutive patients with 148 indeterminate renal lesions were examined with ultrasound combined with CEUS (81 men and 59 women with mean age 63.8 years). RESULTS Altogether, 146 lesions were classified by CEUS in categories according to the Bosniak classification system, or as solid lesions. Mean lesion diameter was 30 mm (range 5-166 mm). Nine lesions were classified as category I, 32 as category II and 59 as category IIF ("non-surgical lesions"). 48 IIF cysts were followed for a minimum of 2 years (mean 4 years and 8 months): three lesions were upgraded to category III (6%) and 45 were stable category. 19 lesions had a more complex cystic appearance: 12 were classified as category III and seven as category IV cysts. 27 lesions were diagnosed as solid, enhancing tumors. In total, 25 patients with lesions of category III, IV and solid ("surgical lesions") underwent renal surgery, with malignancy diagnosed in 18. CONCLUSION In the common setting of indeterminate renal lesions incidentally detected with a CT exam, CEUS has the potential to classify lesions into "non-surgical" and "surgical" categories, providing a platform for urological decision making, while avoiding radiation exposure.
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Affiliation(s)
- Jan Edenberg
- a Department of Radiology , Sykehuset Innlandet Hospital Trust , Lillehammer , Norway
| | - Kaja Gløersen
- a Department of Radiology , Sykehuset Innlandet Hospital Trust , Lillehammer , Norway
| | - Herzi Abdi Osman
- a Department of Radiology , Sykehuset Innlandet Hospital Trust , Lillehammer , Norway
| | - Magne Dimmen
- b Department of Urology , Sykehuset Innlandet Hospital Trust , Lillehammer , Norway
| | - Geir V Berg
- c Department of Research , Sykehuset Innlandet Hospital Trust , Lillehammer , Norway.,d Faculty of Health, Care and Nursing , NTNU , Gjøvik , Norway
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22
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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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Oh TH, Seo IY. The role of Bosniak classification in malignant tumor diagnosis: A single institution experience. Investig Clin Urol 2016; 57:100-5; discussion 105. [PMID: 26981591 PMCID: PMC4791671 DOI: 10.4111/icu.2016.57.2.100] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 01/20/2016] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To evaluate the clinical reliability of the Bosniak classification in Korea, and to identify independent predictors of malignancy in complicated renal cysts. MATERIALS AND METHODS We reviewed the records of 368 patients with renal cysts between January 2001 and December 2014; 14 patients were excluded, due to interobserver variability in Bosniak classification between the radiologist and urologist. Clinical characteristics and radiologic findings of malignant cystic masses were analyzed, retrospectively. RESULTS In 324 surgically excised lesions from patients (n=312) with renal cysts, the percentages of malignancy in the different Bosniak classifications were as follows: category I, 1.0% (1 of 103); II, 3.8% (2 of 53); IIF, 17.1% (7 of 41); III, 38.0% (27 of 71); and IV, 82.1% (46 of 56). Mean age and lesion size were 59.88±11.9 years (180 men, 144 women) and 5.47±3.51 cm, respectively. Univariate analysis identified hypertension (p=0.011), a history of smoking (p=0.038), and obesity (p=0.015) as the strongest risk factors of malignancy. In a study of Bosniak category III patients, hypertension (p=0.018), lesion size (p<0.001), and difference of Hounsfield Unit (HU) (p=0.027) were the strongest risk factors of malignancy. Multivariate analysis identified lesion size as the strongest potential predictor of malignancy, followed by hypertension and difference of HU. CONCLUSIONS Risk factors of malignancy in complicated renal cyst patients were not different from those published previously. In Bosniak category III lesions, hypertension and lesion size were the strongest predictors of malignancy. Characteristically, the lesion size was smaller than in benign complicated renal cysts, in contrast with other categories.
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Affiliation(s)
- Tae Hoon Oh
- Department of Urology, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea
| | - Ill Young Seo
- Department of Urology, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea
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Lanchon C, Fiard G, Long JA. [Management of cystic renal masses: Review of the literature]. Prog Urol 2015; 25:675-82. [PMID: 26138648 DOI: 10.1016/j.purol.2015.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 05/19/2015] [Accepted: 05/29/2015] [Indexed: 12/26/2022]
Abstract
INTRODUCTION The expansion of renal cysts diagnosis in the population entails to learn how to properly identify and treat potentially malignant lesions. The aim of this review article is to discuss anatomical and pathological characteristics as well as treatment of cystic renal tumors. METHOD A literature review of Medline publications on renal cysts and cystic tumors was conducted. Prospective and retrospective studies in adults, and previous reviews were analyzed. RESULTS Bosniak classification of renal cysts is used worldwide among urologists and radiologists to categorize cystic lesions according to their potential malignancy. There is a 0, 15, 50 and 95 % chance of cancerous cells in Bosniak I, II, III, and IV, respectively. The most frequent pathology is renal cell carcinoma, usually low grade and low stage. Category IIF cysts (F for follow-up) have a 25 % chance of malignancy and require surveillance at 6 months and regularly for 5 years. The follow-up can be done with CT imaging, MRI or contrast enhanced ultrasonography. Cyst biopsy, which was not recommended for a long time, could prevent 40 % of unnecessary surgeries for benign lesions. Bosniak category I and II cysts can be treated if symptomatic, by sclerotherapy or laparoscopic deroofing of the cyst. Category III and IV lesions must be treated as malignant tumors with security margins. CONCLUSION Diagnosis and treatment of Bosniak category IIF renal cysts remain the primary challenge for physicians in cystic renal tumor management. Biopsies of renal cysts seem reliable, with no risk of malignant cell dissemination.
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Affiliation(s)
- C Lanchon
- Service d'urologie et transplantation rénale, CHU de Grenoble, 38043 Grenoble cedex 9, France; Laboratoire TIMC-IMAG, domaine de la Merci, 38700 La Tronche, France
| | - G Fiard
- Service d'urologie et transplantation rénale, CHU de Grenoble, 38043 Grenoble cedex 9, France; Laboratoire TIMC-IMAG, domaine de la Merci, 38700 La Tronche, France
| | - J-A Long
- Service d'urologie et transplantation rénale, CHU de Grenoble, 38043 Grenoble cedex 9, France; Laboratoire TIMC-IMAG, domaine de la Merci, 38700 La Tronche, France.
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Bhat GS, Burude VA, Hegde SD, Tembadamani VS. Isolated renal hydatid cyst masquerading as cystic renal cell carcinoma: a case report. J Clin Diagn Res 2015; 9:PD07-8. [PMID: 25954664 DOI: 10.7860/jcdr/2015/11488.5730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 01/27/2015] [Indexed: 01/27/2023]
Abstract
Incidentally detected renal cysts are always a diagnostic challenge especially when they present with equivocal features on imaging. Proper diagnosis is of paramount importance as it affects the treatment decisions. Septal and nodular enhancement on computed tomography (CT) is the strongest predictor of malignant process. A multilocular cystic lesion with heterogeneity on CT goes in favour of hydatid disease. Though the treatment in both these cases is surgical excision, a more careful study of image may ease the treatment planning process much more. We report a case in middle aged lady who presented with vague abdominal pain with loss of weight, who was found to have a cystic mass in the upper pole of the left kidney on imaging turned out to be hydatid cyst though the radiological features were in favour of cystic renal cell carcinonoma.
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Affiliation(s)
- Gajanan Shripad Bhat
- Consultant Urologist, TSS Shripad Hegde Kadave Institute of Medical Sciences , Sirsi, Karnataka, India
| | - Vijaykumar Amburao Burude
- Consultant Surgeon, TSS Shripad Hegde Kadave Institute of Medical Sciences , Sirsi, Karnataka, India
| | - Suman Dinesh Hegde
- Consultant Pathologist, Shri Mahalaxmi Memorial Hospital , Sirsi, Karnataka, India
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Graumann O, Osther SS, Karstoft J, Hørlyck A, Osther PJS. Bosniak classification system: inter-observer and intra-observer agreement among experienced uroradiologists. Acta Radiol 2015; 56:374-83. [PMID: 24682404 DOI: 10.1177/0284185114529562] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The Bosniak classification is a diagnostic tool for the differentiation of cystic changes in the kidney. The process of categorizing renal cysts may be challenging, involving a series of decisions that may affect the final diagnosis and clinical outcome such as surgical management. PURPOSE To investigate the inter- and intra-observer agreement among experienced uroradiologists when categorizing complex renal cysts according to the Bosniak classification. MATERIAL AND METHODS The original categories of 100 cystic renal masses were chosen as "Gold Standard" (GS), established in consensus by two experienced uroradiologists. Three experienced uroradiological readers were blinded from the previous CT reports. Weighted κ was calculated to assess agreement, defined as: fair, 0.21-0.40; moderate, 0.41-0.60; good, 0.61-0.80; and very good, 0.81-1.00. RESULTS For readers the distribution of correctly classified lesions were as follows: BI, 95-100%; BII, 59-93%; BIIF, 54-92%; BIII, 58-95%; and B IV, 77-100% for the first review. Weighted κ for inter-observer/intra-observer variation was for Reader A: 0.85/0.99, Reader B: 0.97/0.99, and Reader C: 0.98/0.99, (P ≤ 0.001). CONCLUSION According to the calculated weighted κ all readers performed "very good" for both inter-observer and intra-observer variation. Most variation was seen in cysts catagorized as Bosniak II, IIF, and III. These results show that radiologists who evaluate complex renal cysts routinely may apply the Bosniak classification reproducibly.
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Affiliation(s)
- Ole Graumann
- Urological Research Center, Department of Urology, Fredericia Hospital, Fredericia, and Institute of Regional Health Services Research, University of Southern Denmark, Denmark
| | - Susanne S Osther
- Urological Research Center, Department of Urology, Fredericia Hospital, Fredericia, and Institute of Regional Health Services Research, University of Southern Denmark, Denmark
| | - Jens Karstoft
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Arne Hørlyck
- Department of Radiology, Aarhus University Hospital, Skejby, Denmark
| | - Palle JS Osther
- Urological Research Center, Department of Urology, Fredericia Hospital, Fredericia, and Institute of Regional Health Services Research, University of Southern Denmark, Denmark
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Monn MF, Gellhaus PT, Patel AA, Masterson TA, Tann M, Boris RS. Can radiologists and urologists reliably determine renal mass histology using standard preoperative computed tomography imaging? J Endourol 2014; 29:391-6. [PMID: 25222030 DOI: 10.1089/end.2014.0560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE To determine the extent to which radiologists and urologists can predict histology using multiphasic CT imaging. METHODS Patients with a preoperative multiphasic CT undergoing surgery for a renal mass were identified between 2003 and 2013. Tumors >10 cm, locally advanced or metastatic disease, and patients managed by reviewers were excluded. A survey and deidentified scans were provided to reviewers. Sensitivity and accuracy in predicting histology was calculated for each reviewer. Correlation was assessed by the Fleiss kappa coefficient. Multivariable logistic regression determined factors associated with predictive accuracy for final pathology. RESULTS There were 120 patients who met criteria. Mean tumor size was 3.3 cm; there were 102 (85%) that were malignant, and 73% of these were clear-cell renal-cell carcinoma (RCC). The most common benign histology was angiomyolipoma (n=10, 56%) followed by oncocytoma (n=5, 28%). Correlation among reviewers was statistically fair for predicting malignant (κ=0.25) and final pathology (κ=0.22). Sensitivity for predicting malignant masses was 90%. Reviewers accurately predicted malignant pathology in 82% of cases and predicted final pathology in 58% of cases. Adjusted for size, scan type, and reviewer, clear-cell RCC vs benign histology was associated with 21 times increased odds of accurate pathologic identification (P<0.001). CONCLUSIONS Urologists and radiologists were able to accurately identify malignant histology in 82% of cases, although sensitivity for malignant histology was 90%. Developing a preoperative nomogram for identification of clear-cell RCC may be feasible and should be further explored.
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Affiliation(s)
- M Francesca Monn
- 1 Department of Urology, Indiana University School of Medicine , Department of Urology, Indianapolis, Indiana
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Ellimoottil C, Greco KA, Hart S, Patel T, Sheikh MM, Turk TMT, Flanigan RC. New modalities for evaluation and surveillance of complex renal cysts. J Urol 2014; 192:1604-11. [PMID: 25072181 DOI: 10.1016/j.juro.2014.07.099] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2014] [Indexed: 12/12/2022]
Abstract
PURPOSE The increased use of abdominal imaging has led to more frequent detection of incidental renal cysts. Since the inception of the Bosniak classification system, management of Bosniak I, III and IV cysts has been clearly defined, while evaluation and management of Bosniak II and IIF cysts have remained a clinical dilemma. Discussions of new imaging modalities are becoming increasingly prevalent in the radiological literature. In this context we performed a comprehensive review of the recent literature on complex renal cysts focusing on new imaging modalities, surveillance strategies and biopsy. MATERIALS AND METHODS We performed a comprehensive literature review of articles published from January 1, 1998 through December 31, 2013 via MEDLINE(®), EMBASE and the Cochrane Collection using a predetermined search strategy. All studies included were performed in humans older than 18 years, were written in English and had an abstract available for review. We grouped studies into 1 of 5 categories, ie computerized tomography, magnetic resonance imaging, ultrasound, biopsy and surveillance. RESULTS While computerized tomography and magnetic resonance imaging with and without contrast enhancement remain the gold standard to evaluate cystic lesions of the kidney, diffusion-weighted magnetic resonance imaging and contrast enhanced ultrasound have surfaced as new tools for assessment of complex cysts. Comparative effectiveness studies on these new imaging modalities are limited. Image guided biopsy has increasingly been shown to be useful for evaluation of intermediate (Bosniak II and IIF) complex cysts. We found few studies providing guidance on the duration and/or intensity of surveillance required for intermediate complex renal cysts. CONCLUSIONS Although new and enhanced techniques are in development and may be useful in the future management of complex renal cysts, there is a paucity of data regarding the value of these new techniques. Future research should focus on surveillance of intermediate complex renal cysts, particularly on the ideal frequency and type of imaging required.
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Affiliation(s)
- Chandy Ellimoottil
- Department of Urology, Loyola University Medical Center, Maywood, Illinois.
| | - Kristin A Greco
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
| | - Spencer Hart
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
| | - Tejas Patel
- Department of Radiology, Loyola University Medical Center, Maywood, Illinois
| | - M Mukarram Sheikh
- Department of Radiology, Loyola University Medical Center, Maywood, Illinois
| | - Thomas M T Turk
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
| | - Robert C Flanigan
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
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Reese AC, Johnson PT, Gorin MA, Pierorazio PM, Allaf ME, Fishman EK, Netto GJ, Pavlovich CP. Pathological characteristics and radiographic correlates of complex renal cysts. Urol Oncol 2014; 32:1010-6. [PMID: 25022857 DOI: 10.1016/j.urolonc.2014.02.022] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 02/28/2014] [Accepted: 02/28/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To characterize pathological and cancer-specific outcomes of surgically resected cystic renal tumors and to identify clinical or radiographic features associated with these outcomes. METHODS AND MATERIALS All patients at our institution who underwent radical or partial nephrectomy for complex renal cystic masses between 2004 and 2011 with available computed tomographic imaging were included. The Bosniak score was determined, as were 10 specific radiographic characteristics of renal cysts in patients with preoperative imaging available for review. These characteristics were correlated with cystic mass histopathology. Recurrence-free survival after surgery was determined. RESULTS Overall, 133 patients underwent renal surgery for complex cystic lesions, 89 (67%) of whom had malignant lesions. Malignancy risk increased with Bosniak score (P≤0.01) and presence of mural nodules (P = 0.01). Most (63%) malignancies demonstrated clear cell histology. The papillary renal cell carcinomas (25%) exhibited lower enhancement levels (P = 0.04) and were less often septated (P<0.01). Of the malignancies, 79% were low stage (pT1), and 73% were Fuhrman grade 1 or 2. Large cyst size was associated with advanced tumor stage (P = 0.05). Neither Bosniak score nor any other radiographic parameter was associated with Fuhrman grade. In 70 patients with a median follow-up of 43 months, only 1 (1.4%) developed disease recurrence. CONCLUSIONS Most cystic renal malignancies are low-stage, low-grade lesions. Papillary renal cell carcinomas account for nearly a quarter of cystic renal malignancies and have unique radiographic characteristics. Disease recurrence after surgical resection is rare. These findings suggest an indolent behavior for cystic renal tumors, and these lesions may be amenable to active surveillance.
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Affiliation(s)
- Adam C Reese
- Department of Urology, Temple University School of Medicine, Philadelphia, PA; The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Pamela T Johnson
- Department of Urology, Temple University School of Medicine, Philadelphia, PA; The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Michael A Gorin
- Department of Urology, Temple University School of Medicine, Philadelphia, PA; The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Phillip M Pierorazio
- Department of Urology, Temple University School of Medicine, Philadelphia, PA; The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mohamad E Allaf
- Department of Urology, Temple University School of Medicine, Philadelphia, PA; The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Elliot K Fishman
- Department of Urology, Temple University School of Medicine, Philadelphia, PA; The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - George J Netto
- Department of Urology, Temple University School of Medicine, Philadelphia, PA; The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christian P Pavlovich
- Department of Urology, Temple University School of Medicine, Philadelphia, PA; The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
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Seppala N, Kielar A, Dabreo D, Duigenan S. Inter-rater agreement in the characterization of cystic renal lesions on contrast-enhanced MRI. ACTA ACUST UNITED AC 2014; 39:1267-73. [DOI: 10.1007/s00261-014-0162-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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El-Mokadem I, Budak M, Pillai S, Lang S, Doull R, Goodman C, Nabi G. Progression, interobserver agreement, and malignancy rate in complex renal cysts (≥Bosniak category IIF). Urol Oncol 2014; 32:24.e21-7. [DOI: 10.1016/j.urolonc.2012.08.018] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 08/16/2012] [Accepted: 08/20/2012] [Indexed: 11/26/2022]
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Contrast enhanced ultrasound of the kidneys: what is it capable of? BIOMED RESEARCH INTERNATIONAL 2013; 2013:595873. [PMID: 24455707 PMCID: PMC3884609 DOI: 10.1155/2013/595873] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 09/22/2013] [Accepted: 09/30/2013] [Indexed: 12/20/2022]
Abstract
One of the many imaging uses of contrast enhanced ultrasound (CEUS) is studying a wide variety of kidney pathology, due to its ability to detect microvascular blood flow in real time without affecting renal function. CEUS enables dynamic assessment and quantification of microvascularisation up to capillary perfusion. The objective of this paper is to briefly refresh basic knowledge of ultrasound (US) contrast agents' physical properties, to study technical details of CEUS scanning in the kidneys, and to review the commonest renal indications for CEUS, with imaging examples in comparison to baseline unenhanced US and computed tomography when performed. Safety matters and limitations of CEUS of the kidneys are also discussed.
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Goenka AH, Remer EM, Smith AD, Obuchowski NA, Klink J, Campbell SC. Development of a Clinical Prediction Model for Assessment of Malignancy Risk in Bosniak III Renal Lesions. Urology 2013; 82:630-5. [DOI: 10.1016/j.urology.2013.05.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 05/06/2013] [Accepted: 05/14/2013] [Indexed: 11/29/2022]
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Smith AD, Remer EM, Cox KL, Lieber ML, Allen BC, Shah SN, Herts BR. Bosniak Category IIF and III Cystic Renal Lesions: Outcomes and Associations. Radiology 2012; 262:152-60. [DOI: 10.1148/radiol.11110888] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Characterization of Atypical Cystic Renal Masses With MDCT: Comparison of 5-mm Axial Images and Thin Multiplanar Reconstructed Images. AJR Am J Roentgenol 2010; 195:693-700. [DOI: 10.2214/ajr.09.3113] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Mixed epithelial and stromal tumor of the kidney: an analysis of multidetector computed tomography manifestations and clinicopathologic findings. J Comput Assist Tomogr 2010; 34:177-81. [PMID: 20351499 DOI: 10.1097/rct.0b013e3181c78fa3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To explore the features of mixed epithelial and stromal tumor of kidney (MESTK) on the images of multidetector computed tomography with clinical manifestations and pathological findings as a reference. METHODS On the basis of a blind retrospective review, we analyzed the images of 6 cases of MESTK on multidetector computed tomography and compared them with pathological results postoperatively. Two reviewers were asked to classify the tumors according to the Bosniak classification. We also combined them with clinical data, pathological findings, and reviewed literatures. RESULTS All tumors were single, unilateral, and well circumscribed with a clear delineation from renal parenchyma. Five were round or oval, whereas 1 was irregularly shaped. One tumor processed to renal pelvis, 1 protruded from the cortex, and 4 large masses processed to both the cortex and the pelvis. In 6 cases, all MESTKs consisted of an irregular mixture of solid and cystic areas. The cysts were multilocular with smooth walls and low-density cystic liquid. No mural nodules were observed. Five tumors were diagnosed as Bosniak III, and 1 as Bosniak IV. Solid parts presented a mild-to-moderate enhancement and delayed enhancement without any enhancement of the cystic ones. CONCLUSIONS Radiologists should consider the possibility of MESTK when they find that the tumor is a single solid or a cystic solid mass, especially in a female patient, and that the solid components present a mild-to-moderate enhancement during the corticomedullary phase and delayed enhancement, but the definite diagnosis depends on pathology.
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Johnson PT, Horton KM, Fishman EK. Optimizing Detectability of Renal Pathology With MDCT: Protocols, Pearls, and Pitfalls. AJR Am J Roentgenol 2010; 194:1001-1012. [DOI: 10.2214/ajr.09.3049] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Pamela T. Johnson
- All authors: The Russell H. Morgan Department of Radiology and Radiologic Science, Johns Hopkins Hospital, 601 N Caroline St., Rm. 3140D, Baltimore, MD 21287
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Abstract
OBJECTIVE The purpose of our study was to review the clinical correlates and imaging features of benign and malignant cystic renal masses. CONCLUSION This article reviews the radiologic findings of cystic renal lesions. After completing this article, readers should be able to recognize the more common complex cystic renal lesions.
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Song C, Min GE, Song K, Kim JK, Hong B, Kim CS, Ahn H. Differential diagnosis of complex cystic renal mass using multiphase computerized tomography. J Urol 2009; 181:2446-50. [PMID: 19375094 DOI: 10.1016/j.juro.2009.01.111] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Indexed: 10/20/2022]
Abstract
PURPOSE We evaluated the additional usefulness of multiphase computerized tomography for improving the differential diagnosis of cystic renal masses by the Bosniak classification. MATERIALS AND METHODS We reviewed the records of 104 patients with Bosniak class II (29 or 27.8%), III (38 or 36.5%) and IV (37 or 35.7%) cystic renal masses managed surgically between 1997 and 2007. On preoperative multiphase computerized tomography enhancement differences in HU between the precontrast and corticomedullary phases were measured at the highest enhancement area to correlate with pathological findings. RESULTS Renal cell carcinoma was diagnosed in 56 patients (53.8%). Of the tumors 35 (62.5%) showed clear cell histology. According to Bosniak class 3 (11.5%), 21 (55.2%) and 32 (86.4%) class II to IV lesions, respectively, were diagnosed as renal cell carcinoma. For renal cell carcinoma and benign cysts mean HU at the precontrast phase was similar (31.5 and 32.4 HU, respectively), while renal cell carcinoma showed a significantly higher measurement at the corticomedullary phase (112.9 vs 59.8 HU, p <0.0001). To differentiate renal cell carcinoma a corticomedullary phase minus precontrast phase value of greater than 42 HU was predictive with 97.1% sensitivity and 85.7% specificity (area under the ROC curve 0.966). In a multiple regression model the corticomedullary phase minus precontrast phase value and the Bosniak classification independently determined malignant pathological findings (corticomedullary phase minus precontrast phase greater than 42 HU HR 31.541, 95% CI 8.320-119.563 and Bosniak class HR 5.545, 95% CI 2.153-14.279, each p <0.0001). CONCLUSIONS In cases of complex cystic renal masses diagnostic accuracy can be improved to differentiate renal cell carcinoma by combining Bosniak class and enhancement differences measured on multiphase computerized tomography between precontrast and maximal enhancement phases. This would help determine the need for and the method of surgical treatment.
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Affiliation(s)
- Cheryn Song
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Bach AM, Zhang J. Contemporary Radiologic Imaging of Renal Cortical Tumors. Urol Clin North Am 2008; 35:593-604; vi. [DOI: 10.1016/j.ucl.2008.07.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Comparison of contrast-enhanced sonography with unenhanced sonography and contrast-enhanced CT in the diagnosis of malignancy in complex cystic renal masses. AJR Am J Roentgenol 2008; 191:1239-49. [PMID: 18806171 DOI: 10.2214/ajr.07.3546] [Citation(s) in RCA: 175] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The objective of our study was to evaluate contrast-enhanced sonography in the diagnosis of malignancy in complex cystic renal masses. MATERIALS AND METHODS We analyzed a series of 40 cystic renal masses (diameter, 2-8 cm) with a complex pattern at contrast-enhanced CT in 40 consecutive subjects (18 men, 22 women; mean age +/- SD, 62 +/- 11 years). Each renal mass was scanned using sonography without contrast material and after IV injection of sulfur hexafluoride-filled microbubbles during the arterial (15-40 seconds) and venous (40-120 seconds from injection) phases. Two radiologists in consensus assessed onsite the enhancement patterns in the peripheral wall and intracystic septa and the evidence of solid endocystic components. Three blinded readers with 2, 6, and 10 years of experience in renal imaging performed a retrospective off-site interpretation of unenhanced sonography, contrast-enhanced sonography, and CT images and made a benign or malignant diagnosis according to refer ence diagnostic criteria for contrast-enhanced sonography and to the Bosniak classification for CT. RESULTS Final diagnoses comprised two multilocular cystic nephromas, two inflammatory and seven hemorrhagic cysts, and eight uncomplicated benign cysts and 21 cystic renal cell carcinomas. The overall diagnostic accuracy of contrast-enhanced sonography was better than unenhanced sonography and CT (contrast-enhanced sonography vs unenhanced sonography vs CT: reader 1, 83% vs 30% vs 75%; reader 2, 83% vs 30% vs 63%; reader 3, 80% vs 30% vs 70%; p < 0.05, McNemar test). CONCLUSION Contrast-enhanced sonography was found to be better than unenhanced sonography and CT in the diagnosis of malignancy in complex cystic renal masses.
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Sánchez-Martín F, Pascual Queralt M, Martínez-Rodríguez R, Algaba Arrea F, Millán Rodríguez F, Palou Redorta J, Villavicencio Mavrich H. [The cystic component in the renal cancer: conceptual overiew]. Actas Urol Esp 2008; 32:507-16. [PMID: 18605001 DOI: 10.1016/s0210-4806(08)73875-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The renal cancer (RC) cystic component is on the radiological tests and could be consolidate with pathological analysis. The concepts "cystic renal cancer" or "cystic renal tumor" contain a group of entities range from cystic grown pattern RCs to pseudocystic tumors as well as cystic renal diseases coinciding with the RC. The CR and the cystic renal diseases have a great variety to sorts of presentations, giving different ways of radiological images, blending solid and cystic areas. Some papers use indiscriminately expression "cystic" without pathologic proof. Just cystic grown pattern RCs and multilocular cystic carcinoma could be named "cystic renal tumors". For de rest, especially over image study, is more suitable to use expressions as "renal tumor of cystic configuration", while pathologic report are available.
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Ghani KR, Keeler B, Nargund V. Haematuria 2: Imaging investigations, management and follow up. Br J Hosp Med (Lond) 2007; 68:489-93. [PMID: 17953307 DOI: 10.12968/hmed.2007.68.9.27171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Haematuria is a common complaint presenting to doctors in both primary and secondary care. It can be a sign of underlying urinary tract malignancy. Appropriate investigation and management should follow evidence-based practice and recognized guidelines, and subsequently lead to a rapid diagnosis.
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Affiliation(s)
- Khurshid R Ghani
- Department of Urology, St Bartholomew's Hospital, London EC1A 7BE
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