1
|
Lucocq J, Morgan L, Rathod K, Szewczyk-Bieda M, Nabi G. Validation of the updated Bosniak classification (2019) in pathologically confirmed CT-categorised cysts. Scott Med J 2024; 69:18-23. [PMID: 38111318 DOI: 10.1177/00369330231221235] [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] [Indexed: 12/20/2023]
Abstract
INTRODUCTION The updated Bosniak classification in 2019 (v2019) addresses vague imaging terms and revises the criteria with the intent to categorise a higher proportion of cysts in lower-risk groups and reduce benign cyst resections. The aim of the present study was to compare the diagnostic accuracy and inter-observer agreement rate of the original (v2005) and updated classifications (v2019). METHOD Resected/biopsied cysts were categorised according to Bosniak classifications (v2005 and v2019) and the diagnostic accuracy was assessed with reference to histopathological analysis. The inter-observer agreement of v2005 and v2019 was determined. RESULTS The malignancy rate of the cohort was 83.6% (51/61). Using v2019, a higher proportion of malignant cysts were categorised as Bosniak ≥ III (88.2% vs 84.3%) and a significantly higher percentage were categorised as Bosniak IV (68.9% vs 47.1%; p = 0.049) in comparison to v2005. v2019 would have resulted in less benign cyst resections (13.5% vs 15.7%). Calcified versus non-calcified cysts had lower rates of malignancy (57.1% vs 91.5%; RR,0.62; p = 0.002). The inter-observer agreement of v2005 was higher than that of v2019 (kappa, 0.70 vs kappa, 0.43). DISCUSSION The updated classification improves the categorisation of malignant cysts and reduces benign cyst resection. The low inter-observer agreement remains a challenge to the updated classification system.
Collapse
Affiliation(s)
- James Lucocq
- Department of General Surgery, Victoria Hospital Kirkcaldy, Kirkcaldy, UK
| | - Leo Morgan
- Department of General Surgery, Victoria Hospital Kirkcaldy, Kirkcaldy, UK
| | - Ketan Rathod
- Department of Radiology, Ninewells Hospital, Dundee, UK
| | | | - Ghulam Nabi
- Department of Urology, Ninewells Hospital, Division of Imaging Sciences and Technology, School of Medicine, University of Dundee, Dundee, UK
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Herms E, Weirich G, Maurer T, Wagenpfeil S, Preuss S, Sauter A, Heck M, Gärtner A, Hauner K, Autenrieth M, Kübler HP, Holzapfel K, Schwarz-Boeger U, Heemann U, Slotta-Huspenina J, Stock KF. Ultrasound-based "CEUS-Bosniak"classification for cystic renal lesions: an 8-year clinical experience. World J Urol 2023; 41:679-685. [PMID: 35986781 PMCID: PMC10082702 DOI: 10.1007/s00345-022-04094-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 07/07/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Renal cysts comprise benign and malignant entities. Risk assessment profits from CT/MRI imaging using the Bosniak classification. While Bosniak-IIF, -III, and -IV cover complex cyst variants, Bosniak-IIF and -III stand out due to notorious overestimation. Contrast-enhanced ultrasound (CEUS) is promising to overcome this deficit but warrants standardization. This study addresses the benefits of a combined CEUS and CT/MRI evaluation of renal cysts. The study provides a realistic account of kidney tumor boards' intricacies in trying to validate renal cysts. METHODS 247 patients were examined over 8 years. CEUS lesions were graded according to CEUS-Bosniak (IIF, III, IV). 55 lesions were resected, CEUS-Bosniak- and CT/MRI-Bosniak-classification were correlated with histopathological diagnosis. Interobserver agreement between the classifications was evaluated statistically. 105 lesions were followed by ultrasound, and change in CEUS-Bosniak-types and lesion size were documented. RESULTS 146 patients (156 lesions) were included. CEUS classified 67 lesions as CEUS-Bosniak-IIF, 44 as CEUS-Bosniak-III, and 45 as CEUS-Bosniak-IV. Histopathology of 55 resected lesions revealed benign cysts in all CEUS-Bosniak-IIF lesions (2/2), 40% of CEUS-Bosniak-III and 8% of CEUS-Bosniak-IV, whereas malignancy was uncovered in 60% of CEUS-Bosniak-III and 92% of CEUS-Bosniak-IV. Overall, CEUS-Bosniak-types matched CT/MRI-Bosniak types in 58% (fair agreement, κ = 0.28). CEUS-Bosniak resulted in higher stages than CT/MRI-Bosniak (40%). Ultrasound follow-up of 105 lesions detected no relevant differences between CEUS-Bosniak-types concerning cysts size. 99% of lesions showed the same CEUS-Bosniak-type. CONCLUSION The CEUS-Bosniak classification is an essential tool in clinical practice to differentiate and monitor renal cystic lesions and empowers diagnostic work-up and patient care.
Collapse
Affiliation(s)
- Elena Herms
- Department of Nephrology, University Hospital MRI-TUM (München Rechts Der Isar), Munich, Germany
| | - Gregor Weirich
- Institute of Pathology, University Hospital MRI-TUM (München Rechts Der Isar), Munich, Germany
| | - Tobias Maurer
- Department of Urology and Martini-Klinik, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Wagenpfeil
- Institute of Medical Biometry, Epidemiology and Medical Informatics (IMBEI), Saarland University, Campus Homburg, Homburg, Germany
| | - Stephanie Preuss
- Department of Nephrology, University Hospital MRI-TUM (München Rechts Der Isar), Munich, Germany
| | - Andreas Sauter
- Department of Radiology, University Hospital MRI-TUM (München Rechts Der Isar), Munich, Germany
| | - Matthias Heck
- Department of Urology, University Hospital MRI-TUM (München Rechts Der Isar), Munich, Germany
| | - Anita Gärtner
- Department of Anesthesia, Freising University Hospital, Freising, Germany
| | - Katharina Hauner
- Department of Urology, University Hospital MRI-TUM (München Rechts Der Isar), Munich, Germany
| | - Michael Autenrieth
- Department of Urology, University Hospital MRI-TUM (München Rechts Der Isar), Munich, Germany
| | - Hubert P Kübler
- Department of Urology, University Hospital Würzburg, Würzburg, Germany
| | | | - Ulrike Schwarz-Boeger
- Medical Controlling, University Hospital MRI-TUM (München Rechts Der Isar), Munich, Germany
| | - Uwe Heemann
- Department of Nephrology, University Hospital MRI-TUM (München Rechts Der Isar), Munich, Germany
| | - Julia Slotta-Huspenina
- Institute of Pathology, University Hospital MRI-TUM (München Rechts Der Isar), Munich, Germany
| | - Konrad Friedrich Stock
- Department of Nephrology, University Hospital MRI-TUM (München Rechts Der Isar), Munich, Germany.
| |
Collapse
|
4
|
[Modern tomography imaging techniques in urological diseases]. Urologe A 2022; 61:374-383. [PMID: 35262753 DOI: 10.1007/s00120-022-01792-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Radiologic imaging is important for the detection, staging and follow-up of urological tumors. Basic therapy decisions for both oncological (surgical vs. systemic therapy, e.g. in testicular cancer) and non-oncological pathologies (interventional vs. conservative therapy, e.g. for ureteral stones) depend largely on the tomographic imaging performed. Due to its almost ubiquitous availability, speed and cost-effectiveness, computed tomography (CT) plays an important role not only in the clarification of abdominal trauma and non-traumatic emergencies, but also in staging and follow-up of oncological patients. However, the level of radiation exposure, impaired renal function and allergies to iodinated contrast media limit the use of CT. Magnetic resonance imaging (MRI) can be a good alternative for many areas of application in oncological and non-oncological imaging due to its high soft tissue differentiation and functional-specific protocols but without the use of ionizing radiation. AIM In the following, the main indications of abdominal and pelvic CT and MRI in urology and their limitations are summarized. RESULTS The areas of application between CT and MRI are increasingly overlapping, since the latest developments in CT continue to further reduce radiation exposure and increase contrast information, while the speed and robustness of MRI are significantly improving at the same time.
Collapse
|