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Complex renal cystic masses: current standards and controversies

  • Urology – Review
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Abstract

Bosniak classification system is the only preoperative diagnostic tool that has proven its efficiency in the management of complex renal cystic masses. However, it is reader dependent, despite its clear definition of each category. The overall incidence of malignancy in each category did not change significantly over the past 20 years. Current limitations are interobserver variability among readers and a fact that a significant proportion of Bosniak III masses have benign character. The goal is to depict these masses preoperatively and spare the patients of unnecessary surgeries, which raises the question: What particular findings will help in differentiating a Bosniak IIF lesion from a Bosniak III lesion? Do we need to define critical variables that could improve accuracy of Bosniak classification by developing a future nomogram or risk calculator? Some radiologists and urologists erroneously tend to group Bosniak II and IIF in one category and observe them regularly. It seems that radiographic growth itself is insufficient factor for intervention. The change of internal architecture and presence of enhancement play the most important role in depicting malignant lesions during the time frame of active surveillance.

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I hereby certify that the manuscript or portions thereof are not under considerations by another journal or electronic publication and have not been previously published. Authors fully support this statement. The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Urology, Medical University of Vienna, AKH, Währinger Gurtel 18-20, 1090, Vienna, Austria

    Peter Weibl, Tobias Klatte, Matthias Waldert & Mesut Remzi

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  1. Peter Weibl
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  2. Tobias Klatte
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  3. Matthias Waldert
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  4. Mesut Remzi
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Correspondence to Peter Weibl.

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Weibl, P., Klatte, T., Waldert, M. et al. Complex renal cystic masses: current standards and controversies. Int Urol Nephrol 44, 13–18 (2012). https://doi.org/10.1007/s11255-010-9864-y

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