Shaish Hiram, Ahmed Firas, Schreiber Jessica, Hindman Nicole M
Department of Radiology, Columbia University Medical Center, 630 W 168th St, New York, NY 10016.
ProHEALTH Care Associates, New Hyde Park, NY.
AJR Am J Roentgenol. 2019 Jun;212(6):1215-1222. doi: 10.2214/AJR.18.20758. Epub 2019 Mar 12.
The purpose of this study was to determine the percentage of small (< 4 cm) Bosniak category 2F, 3, and 4 lesions that regress during active surveillance. In this retrospective study, a hospital database was searched from January 1, 2005, through September 9, 2017, for small (< 4 cm) Bosniak category 2F, 3, and 4 lesions studied with initial and follow-up unenhanced and contrast-enhanced CT or MRI. Prospective Bosniak categories were recorded. Two blinded radiologists retrospectively reassigned Bosniak categories to the initial and last follow-up studies. Interreader variability was analyzed. Rates of stability, regression, and progression were calculated and stratified by size. Logistic regression was used to assess the effects of lesion size, lesion growth, and duration of follow-up on the change in Bosniak categories. The search identified 123 patients (85 men, 38 women) with 138 renal lesions (according to the blinded readings, 83 Bosniak category 2F, 37 category 3, and 18 category 4) and followed for 1-12.3 years (median, 2.7 years). Fifty-one percent (70/138) of the lesions were smaller than 2 cm. Eighty-eight percent (73/83) of category 2F lesions were downgraded or remained stable. Forty-five percent (25/55) of category 3 or 4 lesions were downgraded to 2F or lower. Kappa values were 0.94 between the two readers and 0.72-0.76 between the readers and the prospective Bosniak categories. There was no association between initial size, change in size, or duration of follow-up and change in Bosniak category. Approximately one-half of small (< 4 cm) Bosniak category 3 and 4 cystic renal lesions were downgraded, and the majority (88%) of small Bosniak category 2F lesions regressed or remained stable during active surveillance. Therefore, small size should be a consideration for conservative management.
本研究的目的是确定在主动监测期间缩小的小（<4 cm）博斯尼亚克2F类、3类和4类病变的百分比。在这项回顾性研究中，检索了一家医院2005年1月1日至2017年9月9日的数据库，以查找通过初始和随访期非增强及增强CT或MRI研究的小（<4 cm）博斯尼亚克2F类、3类和4类病变。记录前瞻性博斯尼亚克类别。两名盲法放射科医生对初始和最后一次随访研究进行了博斯尼亚克类别的回顾性重新分类。分析了阅片者间的变异性。计算稳定性、缩小和进展率，并按大小分层。采用逻辑回归评估病变大小、病变生长和随访时间对博斯尼亚克类别变化的影响。检索发现123例患者（85例男性，38例女性）有138个肾病变（根据盲法阅片，83个博斯尼亚克2F类、37个3类和18个4类），随访1 - 12.3年（中位数2.7年）。51%（70/138）的病变小于2 cm。88%（73/83）的2F类病变降级或保持稳定。45%（25/55）的3类或4类病变降级为2F类或更低。两名阅片者之间的kappa值为0.94，阅片者与前瞻性博斯尼亚克类别之间的kappa值为0.72 - 0.76。初始大小、大小变化或随访时间与博斯尼亚克类别变化之间无关联。约一半的小（<4 cm）博斯尼亚克3类和4类肾囊性病变降级，大多数（88%）小博斯尼亚克2F类病变在主动监测期间缩小或保持稳定。因此，小尺寸应作为保守治疗的一个考虑因素。
