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Contemporary assessment of the correlation between Bosniak classification and histological characteristics of surgically removed atypical renal cysts (UroCCR-12 study)



To evaluate and compare pathological characteristics of renal cysts Bosniak IIF, III and IV in light of recent histological classification.

Patients and methods

The French research network for kidney cancer UroCCR conducted a multicentre study on patients treated surgically for a renal cyst between 2007 and 2016. Independent radiological and centralized pathological reviews were performed for every patient. Pathological characteristics were compared to the Bosniak classification.


Of a total 216 patients included, 175 (81.0%) tumours (90.9% of Bosniak IV, 69.8% of Bosniak III) were malignant or had a low malignant potential, with 60% of clear cell renal cell carcinoma (CCRCC), 24% of papillary RCC (PRCC) and 6.9% of multilocular cystic renal tumour of low malignant potential (MCRTLMP). Malignancies were mostly of low pT stage (86.4% of pT1–2), and low ISUP grade (68.0% of 1–2). Bosniak III cysts had a lower rate of CCRCC (46.7 vs. 67.3%), higher rate of PRCC (30 vs. 20.9%) and MCRTLMP (18.3 vs. 0.9%) compared to Bosniak IV (p < 0.001). Low-malignant potential lesions were less likely Bosniak IV and pT3–4 stage was more frequent in Bosniak IV vs. III (15.7 vs. 3.5%; p = 0.04). There were two recurrences (1.1%) and no cancer-related death occurred during follow-up.


These results confirmed that cystic renal malignancies have excellent prognosis. Bosniak III cysts had a low malignant potential, which suggests surveillance could be an option for these lesions.

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Authors and Affiliations



FXN: Project development, data collection, data analysis, manuscript writing. JCB: Project development, data collection, data analysis, manuscript writing. PB: Project development, data collection, manuscript writing. ZEK: Data collection. FA: Data collection. HL: Data collection. SB: Data collection. GF: Data collection. NG: Data collection. FC: Data collection. CN: Data collection. SB: Data collection. GF-H: Data collection. YA: Data collection. VL: Data collection. VV: Data collection. LD: Data collection. MY: Project development, data collection. JMC: Project development, data collection. AM: Project development, ,manuscript editing. NR-L: Project development, data analysis, manuscript editing. KB: Project development, data analysis, manuscript editing.

Corresponding author

Correspondence to François-Xavier Nouhaud.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval/statement of human rights

All procedures performed in this study were in accordance with the ethical standards of the institutional review board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. A signed informed consent form has been obtained for every patient before inclusion.

Additional information

From The French research network for kidney cancer (UroCCR) and The Oncology Committee of the French Urology Association (CCAFU).

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Nouhaud, FX., Bernhard, JC., Bigot, P. et al. Contemporary assessment of the correlation between Bosniak classification and histological characteristics of surgically removed atypical renal cysts (UroCCR-12 study). World J Urol 36, 1643–1649 (2018).

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  • Renal cell carcinoma
  • Renal cysts
  • Bosniak classification
  • Computed tomography
  • Histology
  • Low malignant potential