Abstract
Purpose
Evaluate the fluid percentage (FP) and enhancing solid volume (SV) of small (< 4 cm) Bosniak 2F, 3 and 4 renal lesions and the association with Bosniak category at baseline and follow-up.
Methods
Hospital database was searched from 1/1/2010 to 8/3/2018 for small (< 4 cm) Bosniak 2F, 3 and 4 lesions studied with initial and follow-up C+CT/MRI. Two radiologists blindly assigned Bosniak categories to first and last available studies. One radiologist performed volumetric analysis of each lesion, calculating the FP and SV. Association with Bosniak category was explored.
Results
121 patients (84:37 M:F) were identified with 136 renal lesions (84, 37 and 15 Bosniak category 2F, 3 and 4) and followed for 1–12.3 years (mean 3.5 years). 87% (73/84) of 2F lesions were downgraded or remained stable. 48% (25/52) of 3/4 lesions were downgraded. Higher FP was associated with a lower Bosniak category (p value = 0.0042). Increase in FP was associated with the probability of being downgraded on follow-up (OR 1.03, p value = 0.0036), while increase in fluid volume of lesion was directly associated with change in overall lesion size among lesions that were downgraded (b-estimate = 0.03, p value = 0.0003). All Bosniak 3/4 lesions with initial SV less than 0.05 cc were downgraded.
Conclusion
FP and SV are useful quantitative surrogates for Bosniak category and future behavior, respectively. Growth of small renal lesions by an increase in fluid volume and FP leads to a downgrade in Bosniak category. Initial SV less than 0.05 cc in Bosniak 3/4 lesions suggests possible future downgrade.
Similar content being viewed by others
References
Campbell S, Uzzo RG, Allaf ME, Bass EB, Cadeddu JA, Chang A, Clark PE, Davis BJ, Derweesh IH, Giambarresi L, Gervais DA, Hu SL, Lane BR, Leibovich BC, Pierorazio PM: Renal Mass and Localized Renal Cancer: AUA Guideline. The Journal of urology 2017, 198:520-9
Schoots IG, Zaccai K, Hunink MG, Verhagen P: Bosniak Classification for Complex Renal Cysts Reevaluated: A Systematic Review. The Journal of urology 2017, 198:12-21
Huber J, Winkler A, Jakobi H, Bruckner T, Roth W, Hallscheidt P, Daneshvar K, Hohenfellner M, Pahernik S: Preoperative decision making for renal cell carcinoma: cystic morphology in cross-sectional imaging might predict lower malignant potential. Urologic oncology 2014, 32:37 e1-6
Israel GM, Hindman N, Bosniak MA: Evaluation of cystic renal masses: comparison of CT and MR imaging by using the Bosniak classification system. Radiology 2004, 231:365-71
Moch H: Cystic renal tumors: new entities and novel concepts. Advances in anatomic pathology 2010, 17:209-14
O’Malley RL, Godoy G, Hecht EM, Stifelman MD, Taneja SS: Bosniak category IIF designation and surgery for complex renal cysts. The Journal of urology 2009, 182:1091-5
Pantuck AJ, Zisman A, Belldegrun AS: The changing natural history of renal cell carcinoma. The Journal of urology 2001, 166:1611-23
Park HS, Lee K, Moon KC: Determination of the cutoff value of the proportion of cystic change for prognostic stratification of clear cell renal cell carcinoma. The Journal of urology 2011, 186:423-9
Park JJ, Jeong BC, Kim CK, Seo SI, Carriere KC, Kim M, Park BK, Jeon SS, Lee HM, Choi HY: Postoperative Outcome of Cystic Renal Cell Carcinoma Defined on Preoperative Imaging: A Retrospective Study. The Journal of urology 2016.
Pruthi DK, Liu Q, Kirkpatrick IDC, Gelfond J, Drachenberg DE: Long-Term Surveillance of Complex Cystic Renal Masses and Heterogeneity of Bosniak 3 Lesions. The Journal of urology 2018.
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 2016.
Smith AD, Remer EM, Cox KL, Lieber ML, Allen BC, Shah SN, Herts BR: Bosniak category IIF and III cystic renal lesions: outcomes and associations. Radiology 2012, 262:152-60
Winters BR, Gore JL, Holt SK, Harper JD, Lin DW, Wright JL: Cystic renal cell carcinoma carries an excellent prognosis regardless of tumor size. Urologic oncology 2015, 33:505 e9-13
Bosniak MA: The current radiological approach to renal cysts. Radiology 1986, 158:1-10
Bosniak MA: Problems in the radiologic diagnosis of renal parenchymal tumors. The Urologic clinics of North America 1993, 20:217-30
Bosniak MA: The Bosniak renal cyst classification: 25 years later. Radiology 2012, 262:781-5
Silverman SG, Pedrosa I, Ellis JH, Hindman NM, Schieda N, Smith AD, Remer EM, Shinagare AB, Curci NE, Raman SS, Wells SA, Kaffenberger SD, Wang ZJ, Chandarana H, Davenport MS: Bosniak Classification of Cystic Renal Masses, Version 2019: An Update Proposal and Needs Assessment. Radiology 2019, 292:475-88
Israel GM, Bosniak MA: Pitfalls in renal mass evaluation and how to avoid them. Radiographics 2008, 28:1325-38
Shaish H, Ahmed F, Schreiber J, Hindman NM: Active Surveillance of Small (< 4 cm) Bosniak Category 2F, 3, and 4 Renal Lesions: What Happens on Imaging Follow-Up? AJR American journal of roentgenology 2019:1-8
Hanson JA, Ason R, Weinreb J, Van Dyke A, Mitchell KA: Radiology estimates of viable tumor percentage in hepatocellular carcinoma ablation cavities correlate poorly with pathology assessment. Archives of pathology & laboratory medicine 2013, 137:392-9
Terada N, Arai Y, Kinukawa N, Terai A: The 10-year natural history of simple renal cysts. Urology 2008, 71:7-11; discussion -2
Smith AD, Allen BC, Sanyal R, Carson JD, Zhang H, Williams JH, Collins C, Griswold M, Zhang X: Outcomes and complications related to the management of Bosniak cystic renal lesions. AJR American journal of roentgenology 2015, 204:W550-6
Mousessian PN, Yamauchi FI, Mussi TC, Baroni RH: Malignancy Rate, Histologic Grade, and Progression of Bosniak Category III and IV Complex Renal Cystic Lesions. AJR American journal of roentgenology 2017, 209:1285-90
Hindman NM: Approach to Very Small (< 1.5 cm) Cystic Renal Lesions: Ignore, Observe, or Treat? AJR American journal of roentgenology 2015, 204:1182-9
Hindman NM, Hecht EM, Bosniak MA: Follow-up for Bosniak category 2F cystic renal lesions. Radiology 2014, 272:757-66
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Shaish, H., Ahmed, F., Schreiber, J. et al. Small (< 4 cm) Bosniak renal cysts: association of initial fluid percentage and enhancing solid volume thresholds with future lesion behavior. Abdom Radiol 45, 799–806 (2020). https://doi.org/10.1007/s00261-020-02413-w
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00261-020-02413-w