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Proportion of malignancy in Bosniak classification of cystic renal masses version 2019 (v2019) classes: systematic review and meta-analysis

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Abstract

Objectives

Determine the proportion of malignancy within Bosniak v2019 classes.

Methods

MEDLINE and EMBASE were searched. Eligible studies contained patients with cystic renal masses undergoing CT or MRI renal protocol examinations with pathology confirmation, applying Bosniak v2019. Proportion of malignancy was estimated within Bosniak v2019 class. Risk of bias was assessed using QUADAS-2.

Results

We included 471 patients with 480 cystic renal masses. No class I malignant masses were observed. Pooled proportion of malignancy were class II, 12% (6/51, 95% CI 5–24%); class IIF, 46% (37/85, 95% CI 28–66%); class III, 79% (138/173, 95% CI 68–88%); and class IV, 84% (114/135, 95% CI 77–90%). Proportion of malignancy differed between Bosniak v2019 II–IV classes (p = 0.004). Four studies reported the proportion of malignancy by wall/septa feature. The pooled proportion of malignancy with 95% CI were class III thick smooth wall/septa, 77% (41/56, 95% CI 53–91%); class III obtuse protrusion ≤ 3 mm (irregularity), 83% (97/117, 95% CI 75–89%); and class IV nodule with acute angulation, 86% (50/58, 95% CI 75–93%) or obtuse angulation ≥ 4 mm, 83%, (64/77, 95% CI 73–90%). Subgroup analysis by wall/septa feature was limited by sample size; however, no differences were found comparing class III masses with irregularity to class IV masses (p = 0.74) or between class IV masses by acute versus obtuse angles (p = 0.62).

Conclusion

Preliminary data suggest Bosniak v2019 class IIF masses have higher proportion of malignancy compared to the original classification, controlling for pathologic reference standard. There are no differences in proportion of malignancy comparing class III masses with irregularities to class IV masses with acute or obtuse nodules.

Key Points

• The proportion of malignancy in Bosniak v2019 class IIF cystic masses is 46% (37 malignant/85 total IIF masses, 95% confidence intervals (CI) 28–66%).

• The proportion of malignancy in Bosniak v2019 class III cystic masses is 79% (138/173, 95% CI 68–88%) and in Bosniak v2019 class IV cystic masses is 84% (114/135, 95% CI 77–90%).

• Class III cystic masses with irregularities had similar proportion of malignancy (83%, 97/117, 95% CI 75–89%) compared to Bosniak class IV masses (84%, 114/135, 95% CI 77–90%) overall (p = 0.74) with no difference within class IV masses by acute versus obtuse angulation (p = 0.62).

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Abbreviations

Bosniak v2019:

Bosniak Classification of Cystic Renal Masses version 2019

CI:

Confidence interval

III-OP:

Bosniak class III mass with obtuse protrusion ≤ 3 mm (irregularity)

III-WS:

Bosniak class III mass with wall or septa thickening

IV-AP:

Bosniak class IV mass with acute protrusion of any size

IV-OP:

Bosniak class IV mass with obtuse protrusion ≥ 4 mm

PRISMA-DTA:

Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies

QUADAS-2:

Quality Assessment of Diagnostic Accuracy Studies 2

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Funding

Dr. McInnes and Dr. Schieda were supported by the University of Ottawa Department of Radiology Research Stipend Program. No other authors have relevant funding. None of the funding bodies listed had any role in design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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Authors and Affiliations

  1. Department of Radiology, University of Ottawa, Ottawa, Canada

    Trevor A. McGrath

  2. Department of Radiology, First Medical Center, Chinese PLA General Hospital, Beijing, China

    Xu Bai & Haiyi Wang

  3. Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA

    Aya Kamaya & Justin R. Tse

  4. Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea

    Kye Jin Park & Mi Yeon Park

  5. Clinical Epidemiology Program, Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute, Room c159 Ottawa Hospital Civic Campus, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada

    Matthew D. F. McInnes & Nicola Schieda

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Correspondence to Nicola Schieda.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

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McGrath, T.A., Bai, X., Kamaya, A. et al. Proportion of malignancy in Bosniak classification of cystic renal masses version 2019 (v2019) classes: systematic review and meta-analysis. Eur Radiol 33, 1307–1317 (2023). https://doi.org/10.1007/s00330-022-09102-w

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