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European Radiology
Published in: European Radiology 6/2017

Open Access 01-06-2017 | Urogenital

Malignancy rates and diagnostic performance of the Bosniak classification for the diagnosis of cystic renal lesions in computed tomography – a systematic review and meta-analysis

Authors: Sabina Sevcenco, Claudio Spick, Thomas H. Helbich, Gertraud Heinz, Shahrokh F. Shariat, Hans C. Klingler, Michael Rauchenwald, Pascal A. Baltzer

Published in: European Radiology | Issue 6/2017

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Abstract

Objective

To systematically review the literature on the Bosniak classification system in CT to determine its diagnostic performance to diagnose malignant cystic lesions and the prevalence of malignancy in Bosniak categories.

Methods

A predefined database search was performed from 1 January 1986 to 18 January 2016. Two independent reviewers extracted data on malignancy rates in Bosniak categories and several covariates using predefined criteria. Study quality was assessed using QUADAS-2. Meta-analysis included data pooling, subgroup analyses, meta-regression and investigation of publication bias.

Results

A total of 35 studies, which included 2,578 lesions, were investigated. Data on observer experience, inter-observer variation and technical CT standards were insufficiently reported. The pooled rate of malignancy increased from Bosniak I (3.2 %, 95 % CI 0–6.8, I2 = 5 %) to Bosniak II (6 %, 95 % CI 2.7–9.3, I2 = 32 %), IIF (6.7 %, 95 % CI 5–8.4, I2 = 0 %), III (55.1 %, 95 % CI 45.7–64.5, I2 = 89 %) and IV (91 %, 95 % CI 87.7–94.2, I2 = 36). Several study design-related influences on malignancy rates and subsequent diagnostic performance indices were identified.

Conclusion

The Bosniak classification is an accurate tool with which to stratify the risk of malignancy in renal cystic lesions.

Key points

• The Bosniak classification can accurately rule out malignancy.
• Specificity remains moderate at 74 % (95 % CI 64–82).
• Follow-up examinations should be considered in Bosniak IIF and Bosniak II cysts.
• Data on the influence of reader experience and inter-reader variability are insufficient.
• Technical CT standards and publication year did not influence diagnostic performance.
Appendix
Available only for authorised users
Literature
1.
2.
Ljungberg B, Bensalah K, Bex A, et al (2015) Renal Cell Carcinoma
3.
Bosniak MA (1997) The use of the Bosniak classification system for renal cysts and cystic tumors. J Urol 157:1852–1853CrossRefPubMed
4.
Jalali S, Wohlin C (2012) Systematic Literature Studies: Database Searches vs. Backward Snowballing. In: Proc. ACM-IEEE Int. Symp. Empir. Softw. Eng. Meas. ACM, New York, NY, USA, pp 29–38
5.
Whiting PF, Rutjes AWS, Westwood ME et al (2011) QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 155:529–536CrossRefPubMed
6.
Higgins JPT, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21:1539–1558CrossRefPubMed
7.
Song C, Min GE, Song K et al (2009) Differential diagnosis of complex cystic renal mass using multiphase computerized tomography. J Urol 181:2446–2450CrossRefPubMed
8.
O’Malley RL, Godoy G, Hecht EM et al (2009) Bosniak category IIF designation and surgery for complex renal cysts. J Urol 182:1091–1095CrossRefPubMed
9.
Weibl P, Klatte T, Kollarik B et al (2011) Interpersonal variability and present diagnostic dilemmas in Bosniak classification system. Scand J Urol Nephrol 45:239–244CrossRefPubMed
10.
Smith AD, Remer EM, Cox KL et al (2012) Bosniak category IIF and III cystic renal lesions: outcomes and associations. Radiology 262:152–160CrossRefPubMed
11.
Israel GM, Bosniak MA (2003) Calcification in cystic renal masses: is it important in diagnosis? Radiology 226:47–52CrossRefPubMed
12.
Bielsa Gali O, Arango Toro O, Cortadellas Angel R et al (1999) The preoperative diagnosis of complex renal cystic masses. Arch Esp Urol 52:19–25PubMed
13.
Quaia E, Bertolotto M, Cioffi V et al (2008) Comparison of contrast-enhanced sonography with unenhanced sonography and contrast-enhanced CT in the diagnosis of malignancy in complex cystic renal masses. AJR Am J Roentgenol 191:1239–1249CrossRefPubMed
14.
15.
Pinheiro T, Sepulveda F, Natalin RH et al (2011) Is it safe and effective to treat complex renal cysts by the laparoscopic approach? J Endourol Endourol Soc 25:471–476CrossRef
16.
You D, Shim M, Jeong IG et al (2011) Multilocular cystic renal cell carcinoma: clinicopathological features and preoperative prediction using multiphase computed tomography. BJU Int 108:1444–1449CrossRefPubMed
17.
Han HH, Choi KH, Oh YT et al (2012) Differential diagnosis of complex renal cysts based on lesion size along with the Bosniak renal cyst classification. Yonsei Med J 53:729–733CrossRefPubMedPubMedCentral
18.
Clevert D-A, Minaifar N, Weckbach S et al (2008) Multislice computed tomography versus contrast-enhanced ultrasound in evaluation of complex cystic renal masses using the Bosniak classification system. Clin Hemorheol Microcirc 39:171–178PubMed
19.
Ascenti G, Mazziotti S, Zimbaro G et al (2007) Complex cystic renal masses: characterization with contrast-enhanced US. Radiology 243:158–165CrossRefPubMed
20.
Loock P-Y, Debiere F, Wallerand H et al (2006) Atypical cysts and risk of renal cancer: value and danger of the Bosniak classification. Prog En Urol J Assoc Fr Urol Société Fr Urol 16:292–296
21.
Israel GM, Bosniak MA (2003) Follow-up CT of moderately complex cystic lesions of the kidney (Bosniak category IIF). AJR Am J Roentgenol 181:627–633CrossRefPubMed
22.
23.
Hindman NM, Hecht EM, Bosniak MA (2014) Follow-up for Bosniak category 2F cystic renal lesions. Radiology 272:757–766CrossRefPubMed
24.
Weibl P, Hora M, Kollarik B et al (2015) Management, pathology and outcomes of Bosniak category IIF and III cystic renal lesions. World J Urol 33:295–300CrossRefPubMed
25.
Kim M-H, Yi R, Cho K-S (1987) Choi HJ (2014) Three-phase, contrast-enhanced, multidetector CT in the evaluation of complicated renal cysts: comparison of the postcontrast phase combination. Acta Radiol Stockh Swed 55:372–377
26.
27.
Harisinghani MG, Maher MM, Gervais DA et al (2003) Incidence of malignancy in complex cystic renal masses (Bosniak category III): should imaging-guided biopsy precede surgery? AJR Am J Roentgenol 180:755–758CrossRefPubMed
28.
Limb J, Santiago L, Kaswick J, Bellman GC (2002) Laparoscopic evaluation of indeterminate renal cysts: long-term follow-up. J Endourol Endourol Soc 16:79–82CrossRef
29.
Aronson S, Frazier HA, Baluch JD et al (1991) Cystic renal masses: usefulness of the Bosniak classification. Urol Radiol 13:83–90CrossRefPubMed
30.
El-Mokadem I, Budak M, Pillai S et al (2014) Progression, interobserver agreement, and malignancy rate in complex renal cysts (≥ Bosniak category IIF). Urol Oncol 32:24.e21–27CrossRef
31.
Lang EK, Macchia RJ, Gayle B et al (2002) CT-guided biopsy of indeterminate renal cystic masses (Bosniak 3 and 2F): accuracy and impact on clinical management. Eur Radiol 12:2518–2524CrossRefPubMed
32.
Bata P, Tarnoki AD, Tarnoki DL et al (2014) Bosniak category III cysts are more likely to be malignant than we expected in the era of multidetector computed tomography technology. J Res Med Sci Off J Isfahan Univ Med Sci 19:634–638
33.
Curry NS, Cochran ST, Bissada NK (2000) Cystic renal masses: accurate Bosniak classification requires adequate renal CT. AJR Am J Roentgenol 175:339–342CrossRefPubMed
34.
Siegel CL, Mcfarland EG, Brink JA et al (1997) CT of cystic renal masses: analysis of diagnostic performance and interobserver variation. AJR Am J Roentgenol 169:813–818CrossRefPubMed
35.
Cloix P, Martin X, Pangaud C et al (1996) Surgical management of complex renal cysts: a series of 32 cases. J Urol 156:28–30CrossRefPubMed
36.
Israel GM, Hindman N, Bosniak MA (2004) Evaluation of cystic renal masses: comparison of CT and MR imaging by using the Bosniak classification system. Radiology 231:365–371CrossRefPubMed
37.
Koga S, Nishikido M, Inuzuka S et al (2000) An evaluation of Bosniak’s radiological classification of cystic renal masses. BJU Int 86:607–609CrossRefPubMed
38.
Wilson TE, Doelle EA, Cohan RH et al (1996) Cystic renal masses: a reevaluation of the usefulness of the Bosniak classification system. Acad Radiol 3:564–570CrossRefPubMed
39.
Peng Y, Jia L, Sun N et al (2010) Assessment of cystic renal masses in children: comparison of multislice computed tomography and ultrasound imaging using the Bosniak classification system. Eur J Radiol 75:287–292CrossRefPubMed
40.
Grotemeyer D, Voiculescu A, Iskandar F et al (2009) Renal cysts in living donor kidney transplantation: long-term follow-up in 25 patients. Transplant Proc 41:4047–4051CrossRefPubMed
41.
Spaliviero M, Herts BR, Magi-Galluzzi C et al (2005) Laparoscopic partial nephrectomy for cystic masses. J Urol 174:614–619CrossRefPubMed
42.
Barr RG, Peterson C, Hindi A (2014) Evaluation of indeterminate renal masses with contrast-enhanced US: a diagnostic performance study. Radiology 271:133–142CrossRefPubMed
43.
Nicolau C, Bunesch L, Sebastia C (2011) Renal complex cysts in adults: contrast-enhanced ultrasound. Abdom Imaging 36:742–752CrossRefPubMed
44.
Park BK, Kim B, Kim SH et al (2007) Assessment of cystic renal masses based on Bosniak classification: comparison of CT and contrast-enhanced US. Eur J Radiol 61:310–314CrossRefPubMed
45.
Chen Y, Wu N, Xue T et al (2014) Comparison of contrast-enhanced sonography with MRI in the diagnosis of complex cystic renal masses. J Clin Ultrasound JCU. doi:10.​1002/​jcu.​22232
46.
Ellimoottil C, Greco KA, Hart S et al (2014) New modalities for evaluation and surveillance of complex renal cysts. J Urol 192:1604–1611CrossRefPubMed
Metadata
Title
Malignancy rates and diagnostic performance of the Bosniak classification for the diagnosis of cystic renal lesions in computed tomography – a systematic review and meta-analysis
Authors
Sabina Sevcenco
Claudio Spick
Thomas H. Helbich
Gertraud Heinz
Shahrokh F. Shariat
Hans C. Klingler
Michael Rauchenwald
Pascal A. Baltzer
Publication date
01-06-2017
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 6/2017
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-016-4631-9

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