Frumer Michael, Ben-Meir David, Shenhar Chen, Peard Leslie, Buchanan Amanda F, Hittelman Adam B, Franco Israel
Department of Urology, Rabin Medical Center and Pediatric Urology Unit, Schneider Children's Medical Center of Israel, 4941492, Petah Tikva, Israel.
Tel Aviv University, Tel Aviv, Israel.
Pediatr Nephrol. 2025 Jun 12. doi: 10.1007/s00467-025-06848-5.
Solid renal masses are commonly managed through surgical intervention, while conservative management is the preferred approach for simple renal cysts. However, the optimal management strategies for complex renal cysts in children remain unresolved.
To conduct a meta-analysis of the literature on the modified Bosniak (mBosniak) classification system to assess its diagnostic performance in pediatric complex renal cysts.
A predefined database search (January 1986-December 2023), used the following keywords: Bosniak classification, modified Bosniak, pediatric renal cysts, complex renal cyst, and pediatric renal tumor. Two independent reviewers extracted data on mBosniak categories and their associated pathology diagnoses. The inclusion criteria comprised (1) English-language publications, (2) involving the pediatric population, (3) using the mBosniak classification and (4) incorporating histopathological data.
The quality of studies was assessed using the QUADAS-2 tool. The analysis involved pooling data, performing subgroup analyses, and exploring potential publication bias.
A total of 7 retrospective studies, which included 154 lesions and 368 scan readings, were included. The overall prevalence of intermediate/malignant lesions was 70% (257/368). In distinguishing benign from intermediate/malignant pathology using the mBosniak classification (I-II vs. III-IV), the overall pooled sensitivity, specificity, PPV, and NPV were 0.88 (227/257), 0.74 (82/111), 0.89 (227/256), and 0.73 (82/112), respectively. mBosniak III category showed a PPV of 0.78 (70/90) and mBosniak II category showed a NPV of 0.59 (36/61). From the perspective of pathological diagnoses, 0.24 (29/122) of the readings for intermediate-risk lesions inaccurately categorized the lesions as mBosniak I-II. The diagnostic performance of the classification varies among distinct subgroups of patients and lesion characteristics.
We included studies with pathologically verified lesions only. In addition, aspects of the radiographic follow-up, such as the duration of follow-up, changes in cyst complexity or size over time, and the correlation between specific dynamics and malignancy, could not be evaluated based on the data provided in the included studies.
The mBosniak classification is a less precise tool for stratifying the challenging cases of intermediate-risk lesions, and the relatively low predictive values of the middle categories (II-III) cast doubt on its utility. Clinicians should incorporate additional clinical-epidemiological data for a more accurate assessment of these lesions. Registration number CRD42023493223.
实性肾肿块通常通过手术干预进行处理，而对于单纯性肾囊肿，保守治疗是首选方法。然而，儿童复杂性肾囊肿的最佳管理策略仍未确定。
对关于改良博斯尼亚克（mBosniak）分类系统的文献进行荟萃分析，以评估其在儿科复杂性肾囊肿中的诊断性能。
通过预定义的数据库检索（1986年1月至2023年12月），使用了以下关键词：博斯尼亚克分类、改良博斯尼亚克、儿科肾囊肿、复杂性肾囊肿和儿科肾肿瘤。两名独立的审阅者提取了关于mBosniak分类及其相关病理诊断的数据。纳入标准包括：（1）英文出版物；（2）涉及儿科人群；（3）使用mBosniak分类；（4）纳入组织病理学数据。
使用QUADAS - 2工具评估研究质量。分析包括汇总数据、进行亚组分析以及探索潜在的发表偏倚。
共纳入7项回顾性研究，包括154个病变和368次扫描读数。中间/恶性病变的总体患病率为70%（257/368）。在使用mBosniak分类（I - II级与III - IV级）区分良性与中间/恶性病理时，总体汇总敏感性、特异性、阳性预测值和阴性预测值分别为0.88（227/257）、0.74（82/111）、0.89（227/256）和0.73（82/112）。mBosniak III级的阳性预测值为0.78（70/90），mBosniak II级的阴性预测值为0.59（36/61）。从病理诊断的角度来看，0.24（29/122）的中间风险病变读数将病变错误分类为mBosniak I - II级。该分类的诊断性能在不同的患者亚组和病变特征中有所不同。
我们仅纳入了经病理证实病变的研究。此外，基于纳入研究提供的数据，无法评估影像学随访的各个方面，如随访持续时间、囊肿复杂性或大小随时间的变化以及特定动态与恶性肿瘤之间的相关性。
mBosniak分类对于对具有挑战性的中间风险病变进行分层是一种不太精确的工具，中间类别（II - III级）相对较低的预测价值使其效用受到质疑。临床医生应纳入额外的临床流行病学数据，以更准确地评估这些病变。注册号CRD42023493223。
