Departamento de Urología, Hospital Bakirkoy Doctor Sadi Konuk de Enseñanza e Investigación, Universidad de Ciencias de la Salud, Estanbul, Turquía.
Departamento de Urología, Hospital Bakirkoy Doctor Sadi Konuk de Enseñanza e Investigación, Universidad de Ciencias de la Salud, Estanbul, Turquía.
Actas Urol Esp (Engl Ed). 2020 May;44(4):207-214. doi: 10.1016/j.acuro.2019.11.007. Epub 2020 Mar 5.
The Bosniak classification of cystic renal lesions was first published in 1986 based on computed tomography (CT). In the present study, we aimed to investigate the effect of magnetic resonance imaging (MRI) on Bosniak category compared with CT, and to determine how this effect changed the treatment modality in the evaluation of complex renal cysts.
Data of 144 patients were collected retrospectively. After exclusion criteria, 102 cystic renal lesions with a Bosniak category of at least IIF on CT or MRI between 2013 and 2016 were evaluated by 2abdominal radiologists. The demographic data, Bosniak category, interobserver agreement, and pathologic data of patients who underwent surgery were recorded.
The coherence between MRI and CT was 75.5%. The Bosniak classification of 17 patients was upgraded with MRI, and the treatment modality changed in 10 patients, and they underwent surgery. The Bosniak category was downgraded from III to IIF in 6 patients out of 8 whose Bosniak category was downgraded with MRI and the treatment modality changed. Surgery was performed in one patient out of these 6 patients, and the pathology was reported as benign. Progression was detected in the follow-up at month 18 of 1 patient out of 5, and surgery was performed. The pathology was reported as renal cell carcinoma. The pathology result was reported as RCC in 35 (68.6%) patients out of 51 who underwent surgery. Progression was detected in 7 patients out of 51 who were followed up (13.7%), and the pathology results were reported as RCC. The majority of the malignant tumors were low stage and grade.
MRI may be successfully used in the evaluation of renal cystic lesions. In particular, the challenging Bosniak IIF and all Bosniak III lesions must be evaluated using MRI before making the decision for surgery. The upgrading of Bosniak category with MRI is more possible compared with CT due to its high-contrast resolution, therefore further studies are required to identify whether it was the cause of overtreatment of Bosniak III lesions.
1986 年，基于计算机断层扫描（CT），首次提出了 Bosniak 分类法用于囊性肾病变的诊断。本研究旨在探讨磁共振成像（MRI）对 Bosniak 分类的影响，并确定这种影响如何改变复杂肾囊肿评估中的治疗方式。
回顾性收集了 144 例患者的数据。排除标准后，评估了 2013 年至 2016 年间在 CT 或 MRI 上至少为 IIF 的 102 例囊性肾病变。由 2 名腹部放射科医生记录患者的人口统计学数据、Bosniak 分类、观察者间一致性和手术患者的病理数据。
MRI 与 CT 的一致性为 75.5%。17 例患者的 Bosniak 分类得到升级，10 例患者的治疗方式发生改变并接受了手术。6 例 MRI 分类降级为 IIF 的患者中，有 8 例 Bosniak 分类降级且治疗方式发生改变。其中 1 例患者接受了手术，病理报告为良性。5 例随访患者中，1 例在 18 个月时发现进展，行手术治疗，病理报告为肾细胞癌。51 例接受手术的患者中，35 例（68.6%）病理报告为肾细胞癌。51 例随访患者中，7 例（13.7%）发现进展，病理报告为肾细胞癌。大多数恶性肿瘤分期和分级较低。
MRI 可成功用于囊性肾病变的评估。特别是对于有挑战性的 Bosniak IIF 和所有 Bosniak III 病变，在决定手术前必须使用 MRI 进行评估。与 CT 相比，MRI 更有可能升级 Bosniak 分类，因此需要进一步研究以确定是否这是导致 Bosniak III 病变过度治疗的原因。
