Pediatric Urology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.
Department of Diagnostic Imaging, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Urology. 2021 Mar;149:206-210. doi: 10.1016/j.urology.2020.10.022. Epub 2020 Oct 28.
To examine correlations of the modified Bosniak categories assigned by radiologists to histological results and inter-rater reliability, focusing on intermediate-risk lesions.
The data of pediatric patients who underwent surgery for intermediate-risk complex renal cyst at a tertiary medical center in 2006-2019 were collected retrospectively. Four pediatric radiologists from 2 different medical centers reviewed the available imaging scans, and assigned each to one of the four modified Bosniak classification categories. Binary cohorts of the Bosniak categories (I-II vs III-IV) were compared to the histological results. Diagnostic accuracy (benign- vs intermediate-risk lesion) was calculated for each radiologist and for each imaging modality. Krippendorff's α test was used to measure inter-rater reliability.
The cohort included seven children, each with 1 complex cyst that was rated as intermediate-risk on pathological study. The median age was 1.5 years (IQR 1, 11.9). A correct classification was made in 41/56 imaging readings (sensitivity 73.2%). Applying Krippendorff's test to the binary Bosniak cohorts yielded poor inter-rater agreement (α = 0.08).
Implementation of the modified Bosniak classification in children caused a disconcerting underestimation of intermediate risk. There was a low inter-rater consistency for the categories intended to guide decisions regarding surgery or conservative management. The findings suggest that clinicians should be cautious using the modified Bosniak system for children.
检查放射科医生对组织学结果的改良 Bosniak 分类与观察者间可靠性的相关性，重点关注中危病变。
回顾性收集了 2006 年至 2019 年在一家三级医学中心因中危复杂肾囊肿行手术治疗的儿科患者的数据。来自 2 家不同医疗机构的 4 名儿科放射科医生对现有影像学扫描进行了评估，并将其分为改良 Bosniak 分类的 4 个类别之一。将 Bosniak 类别（I-II 与 III-IV）的二分队列与组织学结果进行比较。计算了每位放射科医生和每种影像学方法的诊断准确性（良性与中危病变）。Krippendorff 的 α 检验用于测量观察者间的可靠性。
该队列包括 7 名儿童，每位儿童均有 1 个经病理检查评定为中危的复杂囊肿。中位年龄为 1.5 岁（IQR 1, 11.9）。41/56 次影像学检查（敏感性 73.2%）做出了正确的分类。将 Krippendorff 检验应用于二分 Bosniak 队列，得到观察者间的一致性较差（α=0.08）。
改良 Bosniak 分类在儿童中的应用导致对中危的明显低估。用于指导手术或保守治疗决策的分类类别之间的观察者间一致性较低。这些发现表明，临床医生在为儿童使用改良 Bosniak 系统时应谨慎。
