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18-12-2024 | Nephrectomy | Research

Clinical value of contrast-enhanced ultrasound combined with quantitative analysis in Bosniak ≥ II cystic renal masses

Authors: Hua-bin He, Xuan-chen Jin, Yun-cai Liu, Yu-xuan Chen, Deep K. Vaishnani, Yong-sheng Xia, Zuo-liu Xie, Xiao-qiao Wang, Li Lan, Man Zhou

Published in: Abdominal Radiology

Abstract

Objective

The 2019 Bosniak classification has improved the precise and detailed quantitative evaluation criteria, making the diagnosis of cystic renal masses (CRMs) more accurate and objective. This study addresses the clinical value of quantitative analysis and aims to investigate the feasibility of combining contrast-enhanced ultrasound (CEUS) with quantitative analysis for diagnosing Bosniak ≥ II CRMs.

Methods

We retrospectively obtained 58 CRMs with confirmed pathology, which underwent CEUS and Contrast-enhanced computer tomography (CECT) evaluations according to Bosniak classification between January 2013 and August 2024. These lesions were divided into benign and malignant groups, followed by a quantitative analysis of the morphological details detected by CEUS. All morphological parameters were compared, and the diagnostic efficiencies were evaluated using receiver operating characteristics (ROC) curves, logistic regression (LR) analysis, and diagnostic curve analysis (DCA). Additionally, a cohort of 72 lesions was monitored for a period of ≥ 3 years, and changes in Bosniak classification were analyzed by categorizing them into stable, upgraded, and downgraded categories.

Results

The analysis revealed no statistically significant difference between CEUS and CECT in our cohort's malignancy predictive rates across different Bosniak grades (p = 0.640). All morphological quantitative parameters showed statistically significant differences between the two groups (p < 0.001). ROC curve analysis revealed that the sum of enhanced wall thickness and enhanced septum thickness among quantitative parameters had the highest AUC value (AUC: 0.9226). Both LR models demonstrated superior clinical diagnostic performance with similar level of accuracy between qualitative and quantitative analysis, as evidenced by ROC (AUC: 0.9470, 0.9619, respectively) and DCA analyses. None of the lesions in the follow-up cohort were upgraded, suggesting that CRMs are relatively stable tumors with a low malignant potential.

Conclusion

This retrospective study demonstrated that CEUS combined with Bosniak classification and quantitative analysis could enhance diagnostic confidence in differentiating Bosniak ≥ II CRMs and could serve as a viable alternative to CECT in specific cases.

Graphical abstract

Ascenti G, Mazziotti S, Zimbaro G, Settineri N, Magno C, Melloni D, Caruso R, Scribano E: Complex cystic renal masses: characterization with contrast-enhanced US. Radiology 2007, 243(1):158-165 https://doi.org/10.1148/radiol.2431051924.CrossRefPubMed

Ragel M, Nedumaran A, Makowska-Webb J: Prospective comparison of use of contrast-enhanced ultrasound and contrast-enhanced computed tomography in the Bosniak classification of complex renal cysts. Ultrasound (Leeds, England) 2016, 24(1):6-16 . https://doi.org/10.1177/1742271x15626959.CrossRefPubMed

Rose TL, Kim WY: Renal Cell Carcinoma: A Review. Jama 2024, 332(12):1001-1010 . https://doi.org/10.1001/jama.2024.12848.CrossRefPubMed

Silverman SG, Pedrosa I, Ellis JH, Hindman NM, Schieda N, Smith AD, Remer EM, Shinagare AB, Curci NE, Raman SS et al: Bosniak Classification of Cystic Renal Masses, Version 2019: An Update Proposal and Needs Assessment. Radiology 2019, 292(2):475-488 . https://doi.org/10.1148/radiol.2019182646.CrossRefPubMed

Chan J, Yan JH, Munir J, Osman H, Alrasheed S, McGrath T, Flood T, Schieda N: Comparison of Bosniak Classification of cystic renal masses version 2019 assessed by CT and MRI. Abdominal radiology (New York) 2021, 46(11):5268-5276 . https://doi.org/10.1007/s00261-021-03236-z.CrossRefPubMed

Shampain KL, Shankar PR, Troost JP, Galantowicz ML, Pampati RA, Schoenheit TR, Shlensky DA, Barkmeier D, Curci NE, Kaza RK et al: Interrater Agreement of Bosniak Classification Version 2019 and Version 2005 for Cystic Renal Masses at CT and MRI. Radiology 2022, 302(2):357-366 . https://doi.org/10.1148/radiol.2021210853.CrossRefPubMed

Krishna S, Schieda N, Pedrosa I, Hindman N, Baroni RH, Silverman SG, Davenport MS: Update on MRI of Cystic Renal Masses Including Bosniak Version 2019. Journal of magnetic resonance imaging : JMRI 2021, 54(2):341-356 . https://doi.org/10.1002/jmri.27364.CrossRefPubMed

Sebastià C, Corominas D, Musquera M, Paño B, Ajami T, Nicolau C: Active surveillance of small renal masses. Insights into imaging 2020, 11(1):63 . https://doi.org/10.1186/s13244-020-00853-y.CrossRefPubMedPubMedCentral

Bosniak MA: The current radiological approach to renal cysts. Radiology 1986, 158(1):1-10 . https://doi.org/10.1148/radiology.158.1.3510019.CrossRefPubMed

10.

Bosniak MA: Problems in the radiologic diagnosis of renal parenchymal tumors. The Urologic clinics of North America 1993, 20(2):217-230.CrossRefPubMed

11.

Zeng SE, Du MY, Yu Y, Huang SY, Zhang D, Cui XW, Dietrich CF: Ultrasound, CT, and MR Imaging for Evaluation of Cystic Renal Masses. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine 2022, 41(4):807-819 . https://doi.org/10.1002/jum.15762.CrossRefPubMed

12.

Sevcenco S, Spick C, Helbich TH, Heinz G, Shariat SF, Klingler HC, Rauchenwald M, Baltzer PA: 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. European radiology 2017, 27(6):2239-2247 . https://doi.org/10.1007/s00330-016-4631-9.CrossRefPubMed

13.

Tames AVC, Fonseca E, Yamauchi FI, Arrais G, de Andrade TCM, Baroni RH: Progression rate in Bosniak category IIF complex renal cysts. Radiologia brasileira 2019, 52(3):155-160 . https://doi.org/10.1590/0100-3984.2018.0038.CrossRefPubMedPubMedCentral

14.

Quaia E, Bertolotto M, Cioffi V, Rossi A, Baratella E, Pizzolato R, Cov MA: Comparison of contrast-enhanced sonography with unenhanced sonography and contrast-enhanced CT in the diagnosis of malignancy in complex cystic renal masses. AJR American journal of roentgenology 2008, 191(4):1239-1249 . https://doi.org/10.2214/ajr.07.3546.CrossRefPubMed

15.

Bertolotto M, Bucci S, Valentino M, Currò F, Sachs C, Cova MA: Contrast-enhanced ultrasound for characterizing renal masses. European journal of radiology 2018, 105:41-48 . https://doi.org/10.1016/j.ejrad.2018.05.015.CrossRefPubMed

16.

Schieda N, Davenport MS, Krishna S, Edney EA, Pedrosa I, Hindman N, Baroni RH, Curci NE, Shinagare A, Silverman SG: Bosniak Classification of Cystic Renal Masses, Version 2019: A Pictorial Guide to Clinical Use. Radiographics : a review publication of the Radiological Society of North America, Inc 2021, 41(3):814–828 . https://doi.org/10.1148/rg.2021200160.

17.

Qiu X, Zhao Q, Ye Z, Meng L, Yan C, Jiang TA: How does contrast-enhanced ultrasonography influence Bosniak classification for complex cystic renal mass compared with conventional ultrasonography? Medicine 2020, 99(7):e19190 . https://doi.org/10.1097/md.0000000000019190.CrossRefPubMedPubMedCentral

18.

Sun M, Wang C, Jiang F, Fang X, Guo B: Diagnostic value and clinical significance of ultrasound combined with CT in cystic renal cell carcinoma. Oncology letters 2019, 18(2):1395-1401 . https://doi.org/10.3892/ol.2019.10422.CrossRefPubMedPubMedCentral

19.

Schieda N, Krishna S, Pedrosa I, Kaffenberger SD, Davenport MS, Silverman SG: Active Surveillance of Renal Masses: The Role of Radiology. Radiology 2022, 302(1):11-24 . https://doi.org/10.1148/radiol.2021204227.CrossRefPubMed

20.

Luomala L, Rautiola J, Järvinen P, Mirtti T, Nisén H: Active surveillance versus initial surgery in the long-term management of Bosniak IIF-IV cystic renal masses. Scientific reports 2022, 12(1):10184 . https://doi.org/10.1038/s41598-022-14056-6.CrossRefPubMedPubMedCentral

21.

Warren KS, McFarlane J: The Bosniak classification of renal cystic masses. BJU international 2005, 95(7):939-942 . https://doi.org/10.1111/j.1464-410X.2005.05442.x.CrossRefPubMed

22.

Angelini L, Gioulis E, Civitareale N, Granata A, Zanza C, Longhitano Y, Zago A, Machin P, Canal F, Serao A et al: Assessment of Contrast-Enhanced Ultrasound (CEUS) and Computed Tomography (CT) diagnostic accuracy in the evaluation of challenging cystic renal masses. Journal of ultrasound 2022, 25(4):905-913 . https://doi.org/10.1007/s40477-022-00683-2.CrossRefPubMedPubMedCentral

23.

Elstob A, Gonsalves M, Patel U: Diagnostic modalities. International journal of surgery (London, England) 2016, 36(Pt C):504-512 . https://doi.org/10.1016/j.ijsu.2016.06.005.CrossRefPubMed

24.

Cantisani V, Bertolotto M, Clevert DA, Correas JM, Drudi FM, Fischer T, Gilja OH, Granata A, Graumann O, Harvey CJ et al: EFSUMB 2020 Proposal for a Contrast-Enhanced Ultrasound-Adapted Bosniak Cyst Categorization - Position Statement. Ultraschall in der Medizin (Stuttgart, Germany : 1980) 2021, 42(2):154–166 . https://doi.org/10.1055/a-1300-1727.

25.

Mandrekar JN: Receiver operating characteristic curve in diagnostic test assessment. Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer 2010, 5(9):1315-1316 . https://doi.org/10.1097/JTO.0b013e3181ec173d.CrossRefPubMed

26.

Sanchez A, Feldman AS, Hakimi AA: Current Management of Small Renal Masses, Including Patient Selection, Renal Tumor Biopsy, Active Surveillance, and Thermal Ablation. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 2018, 36(36):3591-3600 . https://doi.org/10.1200/jco.2018.79.2341.CrossRefPubMed

27.

Kazmierski B, Deurdulian C, Tchelepi H, Grant EG: Applications of contrast-enhanced ultrasound in the kidney. Abdominal radiology (New York) 2018, 43(4):880-898 . https://doi.org/10.1007/s00261-017-1307-0.CrossRefPubMed

28.

Sidhu PS, Cantisani V, Dietrich CF, Gilja OH, Saftoiu A, Bartels E, Bertolotto M, Calliada F, Clevert DA, Cosgrove D et al: The EFSUMB Guidelines and Recommendations for the Clinical Practice of Contrast-Enhanced Ultrasound (CEUS) in Non-Hepatic Applications: Update 2017 (Long Version). Ultraschall in der Medizin (Stuttgart, Germany : 1980) 2018, 39(2):e2-e44 . https://doi.org/10.1055/a-0586-1107.

29.

Schwarze V, Rübenthaler J, Marschner C, Fabritius MP, Rueckel J, Fink N, Puhr-Westerheide D, Gresser E, Froelich MF, Schnitzer ML et al: Advanced Fusion Imaging and Contrast-Enhanced Imaging (CT/MRI-CEUS) in Oncology. Cancers 2020, 12(10). https://doi.org/10.3390/cancers12102821.

30.

Walmer RW, Ritter VS, Sridharan A, Kasoji SK, Altun E, Lee E, Olinger K, Wagner S, Radhakrishna R, Johnson KA et al: The Performance of Flash Replenishment Contrast-Enhanced Ultrasound for the Qualitative Assessment of Kidney Lesions in Patients with Chronic Kidney Disease. Journal of clinical medicine 2023, 12(20). https://doi.org/10.3390/jcm12206494.

31.

Como G, Valotto C, Tulipano Di Franco F, Giannarini G, Cereser L, Girometti R, Zuiani C: Role of contrast-enhanced ultrasound in assessing indeterminate renal lesions and Bosniak ≥2F complex renal cysts found incidentally on CT or MRI. The British journal of radiology 2021, 94(1127):20210707 . https://doi.org/10.1259/bjr.20210707.CrossRefPubMedPubMedCentral

32.

Sun J, Shen X, Zhang N, Zhang Q, Xing K, Liu Y: Combination of conventional ultrasound with quantitative and qualitative analyses of CEUS for the differentiation of benign and malignant breast solid lesions: A modified breast cancer model. Asian journal of surgery 2024. https://doi.org/10.1016/j.asjsur.2024.08.104.CrossRefPubMed

33.

Wu H, Shi J, Gao L, Wang J, Yuan W, Zhang W, Liu Z, Mao Y: Qualitative and quantitative analysis of solid renal tumors by high-frame-rate contrast-enhanced ultrasound. Cancer imaging : the official publication of the International Cancer Imaging Society 2024, 24(1):139 . https://doi.org/10.1186/s40644-024-00788-3.CrossRefPubMed

34.

Isidori AM, Pozza C, Gianfrilli D, Giannetta E, Lemma A, Pofi R, Barbagallo F, Manganaro L, Martino G, Lombardo F et al: Differential diagnosis of nonpalpable testicular lesions: qualitative and quantitative contrast-enhanced US of benign and malignant testicular tumors. Radiology 2014, 273(2):606-618 . https://doi.org/10.1148/radiol.14132718.CrossRefPubMed

35.

Tian H, Wang Q: Quantitative analysis of microcirculation blood perfusion in patients with hepatocellular carcinoma before and after transcatheter arterial chemoembolisation using contrast-enhanced ultrasound. European journal of cancer (Oxford, England : 1990) 2016, 68:82–89 . https://doi.org/10.1016/j.ejca.2016.08.016.

36.

Smaldone MC, Kutikov A, Egleston BL, Canter DJ, Viterbo R, Chen DY, Jewett MA, Greenberg RE, Uzzo RG: Small renal masses progressing to metastases under active surveillance: a systematic review and pooled analysis. Cancer 2012, 118(4):997-1006 . https://doi.org/10.1002/cncr.26369.CrossRefPubMed

37.

Shaish H, Ahmed F, Schreiber J, Hindman NM: Small (< 4 cm) Bosniak renal cysts: association of initial fluid percentage and enhancing solid volume thresholds with future lesion behavior. Abdominal radiology (New York) 2020, 45(3):799-806 . https://doi.org/10.1007/s00261-020-02413-w.CrossRefPubMed

38.

Beisland C, Hjelle KM, Reisaeter LA, Bostad L: Observation should be considered as an alternative in management of renal masses in older and comorbid patients. European urology 2009, 55(6):1419-1427 . https://doi.org/10.1016/j.eururo.2008.12.031.CrossRefPubMed

39.

Mason RJ, Abdolell M, Trottier G, Pringle C, Lawen JG, Bell DG, Jewett MA, Klotz L, Rendon RA: Growth kinetics of renal masses: analysis of a prospective cohort of patients undergoing active surveillance. European urology 2011, 59(5):863-867 . https://doi.org/10.1016/j.eururo.2011.02.023.CrossRefPubMed

40.

Neves JB, Warren H, Santiapillai J, Rode N, Cullen D, Pavlou M, Walkden M, Patki P, Barod R, Mumtaz F et al: Nephron Sparing Treatment (NEST) for Small Renal Masses: A Feasibility Cohort-embedded Randomised Controlled Trial Comparing Percutaneous Cryoablation and Robot-assisted Partial Nephrectomy. European urology 2024, 85(4):333-336 . https://doi.org/10.1016/j.eururo.2023.07.012.CrossRefPubMed

41.

Prins FM, Kerkmeijer LGW, Pronk AA, Vonken EPA, Meijer RP, Bex A, Barendrecht MM: Renal Cell Carcinoma: Alternative Nephron-Sparing Treatment Options for Small Renal Masses, a Systematic Review. Journal of endourology 2017, 31(10):963-975 . https://doi.org/10.1089/end.2017.0382.CrossRefPubMed

42.

Pierorazio PM, Johnson MH, Patel HD, Sozio SM, Sharma R, Iyoha E, Bass EB, Allaf ME: Management of Renal Masses and Localized Renal Cancer: Systematic Review and Meta-Analysis. The Journal of urology 2016, 196(4):989-999 . https://doi.org/10.1016/j.juro.2016.04.081.CrossRefPubMedPubMedCentral

43.

Mir MC, Derweesh I, Porpiglia F, Zargar H, Mottrie A, Autorino R: Partial Nephrectomy Versus Radical Nephrectomy for Clinical T1b and T2 Renal Tumors: A Systematic Review and Meta-analysis of Comparative Studies. European urology 2017, 71(4):606-617 . https://doi.org/10.1016/j.eururo.2016.08.060.CrossRefPubMed

44.

Herms E, Weirich G, Maurer T, Wagenpfeil S, Preuss S, Sauter A, Heck M, Gärtner A, Hauner K, Autenrieth M et al: Ultrasound-based "CEUS-Bosniak"classification for cystic renal lesions: an 8-year clinical experience. World journal of urology 2023, 41(3):679-685 . https://doi.org/10.1007/s00345-022-04094-0.CrossRefPubMed

45.

Campbell SC, Clark PE, Chang SS, Karam JA, Souter L, Uzzo RG: Renal Mass and Localized Renal Cancer: Evaluation, Management, and Follow-Up: AUA Guideline: Part I. The Journal of urology 2021, 206(2):199-208 . https://doi.org/10.1097/ju.0000000000001911.CrossRefPubMed

46.

Nouhaud FX, Bernhard JC, Bigot P, Khene ZE, Audenet F, Lang H, Bergerat S, Fraisse G, Grenier N, Cornelis F et al: Contemporary assessment of the correlation between Bosniak classification and histological characteristics of surgically removed atypical renal cysts (UroCCR-12 study). World journal of urology 2018, 36(10):1643-1649 . https://doi.org/10.1007/s00345-018-2307-6.CrossRefPubMed

47.

Volpe A: The role of active surveillance of small renal masses. International journal of surgery (London, England) 2016, 36(Pt C):518-524 . https://doi.org/10.1016/j.ijsu.2016.06.007.CrossRefPubMed

Title: Clinical value of contrast-enhanced ultrasound combined with quantitative analysis in Bosniak ≥ II cystic renal masses
Authors: Hua-bin He
Xuan-chen Jin
Yun-cai Liu
Yu-xuan Chen
Deep K. Vaishnani
Yong-sheng Xia
Zuo-liu Xie
Xiao-qiao Wang
Li Lan
Man Zhou
Publication date: 18-12-2024
Publisher: Springer US
Keywords: Nephrectomy
Nephrectomy
Nephrectomy
Published in: Abdominal Radiology
Print ISSN: 2366-004X
Electronic ISSN: 2366-0058
DOI: https://doi.org/10.1007/s00261-024-04744-4

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