Siegel C L, McFarland E G, Brink J A, Fisher A J, Humphrey P, Heiken J P
Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA.
AJR Am J Roentgenol. 1997 Sep;169(3):813-8. doi: 10.2214/ajr.169.3.9275902.
Our objective was to assess the clinical usefulness and interobserver variability of the Bosniak classification scheme for characterizing a series of pathologically proven cystic renal lesions imaged with CT.
Seventy pathologically proven cystic renal masses (38 benign, 32 malignant) in 46 patients were reviewed independently by three radiologists. The cystic masses were categorized by each reviewer according to both the Bosniak classification and the receiver operating characteristic (ROC) analysis. Both the individual results for each reader and the pooled results for all three readers were analyzed. Interobserver agreement and discordance in classifying lesions as Bosniak categories I-II or III-IV were assessed.
The distribution of the 70 lesions (based on the average of the three readers) was 22 Bosniak I (0% malignant), eight Bosniak II (13% malignant), 11 Bosniak III (45% malignant), and 29 Bosniak IV (90% malignant). All readers agreed on the Bosniak classification in 59%, or 41 of the 70 lesions (I, 17; II, one: III, four: and IV, 19). Eleven (16%) of the 70 lesions were classified as Bosniak I or II by one reader and as Bosniak III or IV by at least one other reader. The area under the curve for the pooled ROC analysis was calculated to be 0.957. Individual reader values ranged from 0.914 to 0.981. The sensitivities, specificities, and accuracies for the three readers ranged from 94% to 100%, 71% to 92%, and 84% to 93%. Assessment of interobserver variability by kappa analysis yielded scores of .571 and .477 for the Bosniak and ROC analyses, respectively.
Overall, the Bosniak classification scheme is useful for evaluating renal masses: however, interobserver variation in distinguishing. Bosniak II and Bosniak III lesions may present difficulties in recommending surgical versus conservative management.
我们的目的是评估用于对一系列经病理证实的肾囊性病变进行CT成像特征描述的博斯尼亚克分类方案的临床实用性和观察者间的变异性。
46例患者的70个经病理证实的肾囊性肿块（38个良性，32个恶性）由三位放射科医生独立进行回顾。每位阅片者根据博斯尼亚克分类和受试者操作特征（ROC）分析对囊性肿块进行分类。分析了每位阅片者的个体结果以及所有三位阅片者的汇总结果。评估了观察者间在将病变分类为博斯尼亚克I-II类或III-IV类时的一致性和不一致性。
70个病变（基于三位阅片者的平均值）的分布为22个博斯尼亚克I类（0%为恶性），8个博斯尼亚克II类（13%为恶性），11个博斯尼亚克III类（45%为恶性），29个博斯尼亚克IV类（90%为恶性）。所有阅片者对70个病变中的41个（59%）的博斯尼亚克分类达成一致（I类，17个；II类，1个；III类，4个；IV类，19个）。70个病变中有11个（16%）被一位阅片者分类为博斯尼亚克I类或II类，而被至少另一位阅片者分类为博斯尼亚克III类或IV类。汇总ROC分析的曲线下面积经计算为0.957。个体阅片者的值范围为0.914至0.981。三位阅片者的敏感性、特异性和准确性范围分别为94%至100%、71%至92%和84%至93%。通过kappa分析评估观察者间变异性，博斯尼亚克分析和ROC分析的得分分别为0.571和0.477。
总体而言，博斯尼亚克分类方案对于评估肾肿块是有用的；然而，在区分博斯尼亚克II类和博斯尼亚克III类病变时观察者间的差异可能在推荐手术与保守治疗方面带来困难。
