Department of Urology, Health Sciences University, Bozyaka Training and Research Hospital, Izmir, Turkey,
Department of Urology, Health Sciences University, Bozyaka Training and Research Hospital, Izmir, Turkey.
Urol Int. 2021;105(1-2):118-123. doi: 10.1159/000510243. Epub 2020 Nov 26.
Almost half of the cystic renal lesions are still overdiagnosed and overtreated. New clinical and radiological parameters are needed to distinguish the malignant Bosniak 3 lesions from the benign ones. We aimed to evaluate the clinical and radiological parameters that may be related to malignancy risk for Bosniak category 3 renal cysts.
Patients who underwent surgical resection of a histopathologically confirmed Bosniak 3 renal cyst between March 2007 and September 2019 were evaluated. Two experienced uro-radiologists have reevaluated the last preoperative computed tomography and/or MRI images of the patients and reclassified the lesions according to the Bosniak classification. They also reported cystic features such as nodularity, septation, focal thickening, enhancement, and calcification. Clinical, pathological, and oncological outcomes were recorded. Then patients were divided into 2 groups as Group 1 (benign pathology) and Group 2 (malignant pathology) according to final histopathological report.
A total of 79 patients were included in this study. Mean follow-up time was 47 ± 34 months. There were 30 patients in Group 1 and 49 patients in Group 2. Hypertension (p = 0.001) and smoking history (p = 0.008) were more common in malignant group. Among the radiological findings, lower tumor diameter (p = 0.024), presence of cyst wall enhancement (p = 0.025), presence of nodularity (p = 0.002), and presence of focal thickening (p = 0.031) were found to be statistically significant for malignancy. Most of the tumors were at pathological T1 stage and Fuhrmann Grade 1-2. Only nodularity was found to be independent predictive factor for malignancy in multivariate analysis.
Clinical factors including hypertension and smoking, radiological factors including lower lesion size, cyst wall enhancement, nodularity, and focal thickening were predictors for malignancy of Bosniak 3 cysts.
近一半的囊性肾脏病变仍然被过度诊断和过度治疗。需要新的临床和放射学参数来区分恶性 Bosniak 3 病变与良性病变。我们旨在评估可能与 Bosniak 3 类肾脏囊肿恶性风险相关的临床和放射学参数。
评估了 2007 年 3 月至 2019 年 9 月期间接受手术切除经组织病理学证实的 Bosniak 3 类肾脏囊肿的患者。两名经验丰富的泌尿放射科医生重新评估了患者的最后一次术前计算机断层扫描和/或 MRI 图像，并根据 Bosniak 分类重新分类病变。他们还报告了囊性特征，如结节、分隔、局灶性增厚、增强和钙化。记录了临床、病理和肿瘤学结果。然后根据最终组织病理学报告将患者分为 2 组，即第 1 组（良性病理学）和第 2 组（恶性病理学）。
共有 79 名患者纳入本研究。平均随访时间为 47 ± 34 个月。第 1 组有 30 例，第 2 组有 49 例。恶性组中高血压（p = 0.001）和吸烟史（p = 0.008）更为常见。在放射学发现中，肿瘤直径较小（p = 0.024）、囊壁增强（p = 0.025）、存在结节（p = 0.002）和局灶性增厚（p = 0.031）与恶性肿瘤有统计学意义。大多数肿瘤处于病理 T1 期和 Fuhrmann 分级 1-2 级。在多变量分析中，只有结节被发现是恶性的独立预测因素。
包括高血压和吸烟在内的临床因素、包括病变大小较小、囊壁增强、结节和局灶性增厚在内的放射学因素是 Bosniak 3 类囊肿恶性的预测因素。
