Cystic renal masses: accurate Bosniak classification requires adequate renal CT.
OBJECTIVE
The objective of this study was to assess the practical usefulness of the Bosniak classification system for separating surgical from nonsurgical cystic renal masses in a large number of patients examined with properly performed renal CT. The study included only patients whose scans were technically adequate to allow proper assignment of the lesion to a category.


METHODS
The scans of 109 patients were gathered from two large teaching institutions both prospectively and retrospectively, yielding a total of 116 analyzable renal cystic lesions. Eighty-two masses were resected from 77 of these patients, retrospectively categorized by two experienced uroradiologists using the Bosniak classification system, and correlated with pathology reports. A second group of 34 lesions in 32 patients with atypical cysts was followed up prospectively for periods ranging from 3 months to 10 years.


RESULTS
The results were similar for the two institutions: 15 resected categories I and II lesions were correctly identified as benign, and all 18 category IV lesions were malignant. Twenty-nine (59%) of 49 pooled category III masses were malignant. No malignancies have been identified in the prospectively monitored group of patients.


CONCLUSIONS
Our results are compared with earlier, smaller series and support those that show that the Bosniak classification system is useful in separating lesions requiring surgery from those that can be safely followed up, provided proper CT techniques are used.
Department of Radiology, Medical University of South Carolina, Main Hospital, Charleston 29425, USA.
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Bissada
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D052177:Kidney Diseases, Cystic / Q000145:classification* / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed