Department of Urology, University of Kentucky, 800 Rose St., Lexington, KY, 40536, USA.
Department of Urology, 200 1st St. SW, Rochester, MN, 55905, USA.
J Pediatr Urol. 2022 Apr;18(2):180.e1-180.e7. doi: 10.1016/j.jpurol.2021.12.001. Epub 2021 Dec 11.
Pediatric cystic renal lesions are challenging to manage as little is known about their natural course. A modified Bosniak (mBosniak) classification system has been proposed for risk stratification in pediatric patients that takes ultrasound (US) and/or computed tomogram (CT) characteristics into account. However, literature validating this system remains limited.
To determine if the mBosniak classification system correlates with pathologic diagnoses. The hypothesis is that mBosniak classification can stratify the risk of malignancy in children with renal cysts.
Patients treated for cystic renal masses with available imaging and pathology between 2000 and 2019 from five institutions were identified. Clinical characteristics and pathology were obtained retrospectively. Characteristics from the most recent US, CT, and/or magnetic resonance imaging (MRI) were recorded. Reviewers assigned a mBosniak classification to each scan. mBosniak scores 1/2 were considered low-risk and 3/4 high-risk. These groups were compared with pathology (classified as benign, intermediate, malignant). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (+LR), and negative likelihood ratio (-LR) were calculated to assess this categorization as a screening tool to guide surgical intervention. Agreement between imaging modalities was also explored.
99 patients were identified. High-risk imaging findings were correlated with malignant or intermediate pathology with a sensitivity of 88.3%, specificity of 84.6%, PPV of 89.8%, NPV of 82.5%, +LR of 5.7, and -LR of 0.14. The sensitivity for detecting malignant lesions only was 100%. There was substantial agreement between US/CT (n = 55; κ = 0.66) and moderate agreement between US/MRI (n = 20; κ = 0.52) and CT/MRI (n = 13; κ = 0.47).
The mBos classification system is a useful tool in predicting the likelihood of benign vs. intermediate or malignant pathology. The relatively high sensitivity and specificity of the system for prediction of high-risk lesions makes this classification applicable to clinical decision making. In addition, all malignant lesions were accurately identified as mBosniak 4 on imaging. This study adds substantial data to the relatively small body of literature validating the mBosniak system for risk stratifying pediatric cystic renal lesions.
Pediatric cystic renal lesions assigned mBosniak class 1/2 are mostly benign, whereas class 3/4 lesions are likely intermediate or malignant pathology. We observed that the mBosniak system correctly identified pathology appropriate for surgical management in 88% of cases and did not miss malignant pathologies. There is substantial agreement between CT and US scans concerning mBos classification.
小儿囊性肾病变的管理具有挑战性，因为人们对其自然病程知之甚少。已经提出了改良的 Bosniak（mBosniak）分类系统，用于对儿科患者进行风险分层，该系统考虑了超声（US）和/或计算机断层扫描（CT）特征。但是，验证该系统的文献仍然有限。
确定 mBosniak 分类系统是否与病理诊断相关。假设 mBosniak 分类可以对患有肾囊肿的儿童的恶性肿瘤风险进行分层。
从五个机构中确定了 2000 年至 2019 年期间接受囊性肾肿块治疗并具有可用影像学和病理学资料的患者。回顾性获得临床特征和病理学资料。记录最近的 US、CT 和/或磁共振成像（MRI）的特征。由两位审阅者为每个扫描分配 mBosniak 分类。mBosniak 评分 1/2 被认为是低风险，3/4 是高风险。将这些组与病理（分为良性、中间、恶性）进行比较。计算敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）、阳性似然比（+LR）和阴性似然比（-LR），以评估该分类作为指导手术干预的筛查工具。还探讨了影像学之间的一致性。
确定了 99 例患者。高风险的影像学表现与恶性或中间病理相关，敏感性为 88.3%，特异性为 84.6%，PPV 为 89.8%，NPV 为 82.5%，+LR 为 5.7，-LR 为 0.14。检测恶性病变的敏感性为 100%。US/CT（n=55；κ=0.66）之间存在明显的一致性，US/MRI（n=20；κ=0.52）和 CT/MRI（n=13；κ=0.47）之间存在中度一致性。
mBos 分类系统是预测良性与中间或恶性病理可能性的有用工具。该系统预测高危病变的敏感性和特异性相对较高，使其适用于临床决策。此外，所有恶性病变在影像学上均准确地被识别为 mBosniak 4。本研究为验证 mBosniak 系统对小儿囊性肾病变进行风险分层的相对较小的文献提供了大量数据。
小儿囊性肾病变被分配为 mBosniak 1/2 级的大多为良性，而 3/4 级病变可能为中间或恶性病理。我们观察到，mBosniak 系统在 88%的病例中正确识别出适合手术治疗的病理，并且没有遗漏恶性病变。CT 和 US 扫描之间关于 mBos 分类存在高度一致性。
