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No AccessJournal of UrologyAdult Urology1 Sep 2009

Bosniak Category IIF Designation and Surgery for Complex Renal Cysts

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    Purpose:

    We investigated whether adding the IIF categorization improved the accuracy of Bosniak renal cyst classification, as evidenced by a low rate of progression in IIF lesions and a high rate of malignancy in category III lesions.

    Materials and Methods:

    We retrospectively reviewed the records of patients with complex renal cysts categorized as a Bosniak IIF or III. Surveillance imaging and pathological outcomes of category IIF cysts were recorded to determine radiological predictors of progression. Pathological outcomes of category III cysts were recorded to determine the malignancy rate.

    Results:

    A total of 112 patients met study inclusion criteria, of whom 81 were initially diagnosed with a category IIF cyst and 31 had a Bosniak category III cyst. At a median followup of 15 months 14.8% of Bosniak IIF lesions progressed in complexity with a median time to progression of 11 months (maximum greater than 4 years). There were no differences in tumor or patient characteristics between cysts that progressed and those that remained stable. In the 33 patients with Bosniak III lesions who underwent surgical extirpation the malignancy rate was 81.8%. Most patients had low stage, low grade disease and remained recurrence-free at a median followup of 6 months.

    Conclusions:

    Adding the IIF category has increased the accuracy and clinical impact of the Bosniak categorization system, as evidenced by a low rate of progression in category IIF cysts and an increased rate of malignancy in surgically treated category III lesions compared to those in historical controls.

    References

    • 1 : The current radiological approach to renal cysts. Radiology1986; 158: 1. Google Scholar
    • 2 : Cystic renal masses: accurate Bosniak classification requires adequate renal CT. AJR Am J Roentgenol2000; 175: 339. Google Scholar
    • 3 : CT of cystic renal masses: analysis of diagnostic performance and interobserver variation. AJR Am J Roentgenol1997; 169: 813. Google Scholar
    • 4 : Problems in the radiologic diagnosis of renal parenchymal tumors. Urol Clin North Am1993; 20: 217. Google Scholar
    • 5 : Diagnosis and management of patients with complicated cystic lesions of the kidney. AJR Am J Roentgenol1997; 169: 819. Google Scholar
    • 6 : Cystic renal masses: a reevaluation of the usefulness of the Bosniak classification system. Acad Radiol1996; 3: 564. Google Scholar
    • 7 : Surgical management of complex renal cysts: a series of 32 cases. J Urol1996; 156: 28. LinkGoogle Scholar
    • 8 : Cystic renal masses: usefulness of the Bosniak classification. Urol Radiol1991; 13: 83. Google Scholar
    • 9 : Follow-up CT of moderately complex cystic lesions of the kidney (Bosniak category IIF). AJR Am J Roentgenol2003; 181: 627. Google Scholar
    • 10 : MR imaging of cystic renal masses. Magn Reson Imaging Clin N Am2004; 12: 403. Google Scholar
    • 11 : An update of the Bosniak renal cyst classification system. Urology2005; 66: 484. Google Scholar

    Division of Urologic Oncology, Department of Urology, New York University School of Medicine, New York, New York

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