Characterization of complex renal cysts: A critical evaluation of the Bosniak classification
Characterization of complex renal cysts: A critical evaluation of the Bosniak classification
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DOI：
10.3109/00365599.2010.533695
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发表时间：
2011-03-01
影响因子：
--
通讯作者：
Osther, Palle Jorn Sloth
中科院分区：
文献类型：
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作者：
Graumann, Ole;Osther, Susanne Sloth;Osther, Palle Jorn Sloth
客观的。复杂性肾囊肿是一个主要的临床问题，因为通常很难排除恶性肿瘤。基于计算机断层扫描 (CT) 的 Bosniak 分类系统广泛用于对囊性肾病变进行分类。本研究的目的是评估波斯尼亚克分类的重要可用数据。材料和方法。对 Entrez Pubmed 检索的所有出版物进行了审查，重点关注临床适用性以及使用 CT 以外的成像方式对复杂肾囊肿进行分类。结果。发现了十五项回顾性研究。大多数系列研究规模较小，只有 6 项研究涉及 30 多名患者。将这六项研究的结果汇总后，恶性肿瘤的百分比为：I 类，0%；I 类，0%； II类，15.6%； IIF 类，0%； III类，65.3%；第四类，91.7%。仅三项研究包含 IIF 类。磁共振成像和超声造影（US）似乎都与 CT 具有合理的一致性，尽管这两种方法都有使病变升级的趋势。结论。 Bosniak 分类的主要问题在于区分 II 类和 III 类病变，这一点非常重要，因为干预决策是基于这种区分。使用 IIF 类似乎有望检测那些最终会发展为恶性肿瘤的 II 类病变，并减少最初归类为 III 类病变的过度治疗。然而，这种“新”分类策略的科学依据仍然缺失。其他成像方式的数据太有限，无法得出结论。
Objective. Complex renal cysts represent a major clinical problem, since it is often difficult to exclude malignancy. The Bosniak classification system, based on computed tomography (CT), is widely used to categorize cystic renal lesions. The aim of this study was to evaluate critically available data on the Bosniak classification. Material and methods. All publications from an Entrez Pubmed search were reviewed, focusing on clinical applicability and the use of imaging modalities other than CT to categorize complex renal cysts. Results. Fifteen retrospective studies were found. Most series were small, with only six studies comprising more than 30 patients. When the results of these six studies were pooled the percentage of malignancy was: category I, 0%; category II, 15.6%; category IIF, 0%; category III, 65.3%; and category IV, 91.7%. Category IIF was included in only three studies. Both magnetic resonance imaging and contrast-enhanced ultrasonography (US) seemed to have reasonable agreement with CT, although both modalities had a tendency to upgrade lesions. Conclusions. The main problem with the Bosniak classification is in separating category II and III lesions, which is of major importance, since decisions on intervention are based on this separation. The use of category IIF seems promising to detect those category II lesions that eventually will develop into malignancy and reduce overtreatment of lesions originally classified as category III. The scientific basis of this ""new"" classification strategy is, however, still missing. Data on other imaging modalities are too limited for conclusions to be drawn.