Abufaraj Mohammad, Alhanbali Yazeed E, Al-Qalalweh Sarah B, Froukh Ubadah, Sweis Nabil William G, Mahmoud Mohammad Yousef, Kharabsheh Mohamed A O, Samara Osama, Shariat Shahrokh F
Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan; Department of Urology, Medical University of Vienna, Vienna, Austria.
School of Medicine, The University of Jordan, Amman, Jordan.
Urol Oncol. 2025 Mar;43(3):192.e1-192.e10. doi: 10.1016/j.urolonc.2024.10.011. Epub 2024 Oct 28.
The Bosniak classification for cystic renal masses has undergone refinements since its inception. The 2019 version provides more objective criteria to enhance interrater agreement but needs validation. This study compares the interrater agreement of the 2005 and 2019 Bosniak classifications for cystic renal masses.
Forty cystic renal masses identified on computed tomography scans were selected, distributed equally among the five classes of the 2005 Bosniak classification. Eight radiology residents participated in 2 consecutive rating sessions using the 2005 and 2019 versions, respectively, with a 1-month wash-out period in between. Interrater reliability was assessed using Fleiss' κ, and changes in cyst classes between the versions were assessed using the Wilcoxon signed-rank test.
Fleiss' κ values for interrater reliability were 0.354 (0.286-0.431) for 2005 and 0.373 (0.292-0.487) for 2019, indicating fair to moderate agreement. A significant decrease in cyst grades was noted using the 2019 version (Z = 3.49, r = 0.55, P < 0.001) among all cysts assessed by residents and only in complex cysts assessed by consultants (Z = 1.907, r = 0.275, P = 0.048).
Interrater agreement was similar for both classifications, ranging from fair to moderate. The 2019 version increased the proportion of masses downgraded to lower classes. Comprehensive training may enhance reliability and accuracy.
自创立以来，肾囊性肿块的博斯尼亚克分类法不断完善。2019年版提供了更客观的标准以提高评分者间的一致性，但仍需验证。本研究比较了2005年和2019年肾囊性肿块博斯尼亚克分类法的评分者间一致性。
选取40例经计算机断层扫描识别的肾囊性肿块，平均分配到2005年博斯尼亚克分类法的五个类别中。八名放射科住院医师分别使用2005年版和2019年版进行连续两次评级，中间间隔1个月的洗脱期。使用Fleiss' κ评估评分者间的可靠性，使用Wilcoxon符号秩检验评估两个版本之间囊肿类别的变化。
2005年评分者间可靠性的Fleiss' κ值为0.354（0.286 - 0.431），2019年为0.373（0.292 - 0.487），表明一致性为中等。住院医师评估的所有囊肿以及仅顾问评估的复杂囊肿中，使用2019年版时囊肿等级显著降低（Z = 3.49，r = 0.55，P < 0.001）（Z = 1.907，r = 0.275，P = 0.048）。
两种分类法的评分者间一致性相似，从中等到中等。2019年版增加了降级到较低类别的肿块比例。全面培训可能会提高可靠性和准确性。
