Bosniak classification system: inter-observer and intra-observer agreement among experienced uroradiologists

Graumann, Ole; Osther, Susanne Sloth; Karstoft, Jens; Hørlyck, Arne; Osther, Palle J S

doi:10.1177/0284185114529562

Cited by 39 publications

(26 citation statements)

References 25 publications

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“…Bosniak version 2019 had a higher diagnostic specificity for malignancy than did The interobserver agreement in version 2019 was superior to that in previous studies (k = 0.51-0.52) based on MRI (16) or CT (17) scans, probably because of more objective and precise classification criteria. However, agreement was lower than that of other previous studies (k = 0.66-0.85) (10,(18)(19)(20), partially because of the relatively small number of malignant tumors, fewer readers, higher rate of class I and IV CRMs, or the bias in the inclusion of CRMs and establishment of the study cohort in those studies.…”

Section: Comparison Of Interobserver Agreement Between Version 2019 Acontrasting

confidence: 76%

MRI-based Bosniak Classification of Cystic Renal Masses, Version 2019: Interobserver Agreement, Impact of Readers’ Experience, and Diagnostic Performance

Bai¹,

Sun²,

Wang³

et al. 2020

Radiology

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T he Bosniak classification of cystic renal masses (CRMs) has contributed substantially to the stratification of malignancy risk in the 3 decades since it was proposed (1). As a living system, refinements were made in 1993 and 2005 (version 2005) (2-4). With the current version of the Bosniak classification (version 2005), several shortcomings in both clinical practice and scientific research have been noted. A systematic review has suggested that interreader variability for the Bosniak classification is large, ranging from 6% to 75% (5), especially for Bosniak classes II, IIF, and III. This variability is partly explained by relatively subjective classification criteria. Moreover, the reported risk for malignancy of each class of CRM varies widely. For example, the likelihood for Bosniak classes II, IIF, III, and IV is, respectively, 9% (range, 5%-14%), 18% (range, 12%-26%), 51% (range, 42%-61%), and 86% (range, 81%-89%) (5). The high prevalence of a benign finding among Bosniak class III CRMs (approximately 49%) (6) is also a concern because unnecessary surgery may cause potential harm and present no clinical benefit.

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Section: Comparison Of Interobserver Agreement Between Version 2019 Acontrasting

confidence: 76%

MRI-based Bosniak Classification of Cystic Renal Masses, Version 2019: Interobserver Agreement, Impact of Readers’ Experience, and Diagnostic Performance

Bai¹,

Sun²,

Wang³

et al. 2020

Radiology

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“…It is probable that most urologists in tertiary centres tend to manage these patients similarly, but this guide can be used by primacy care or office urologists to counsel their patients appropriately. The major known drawback of the BCS is the substantial inter- and intra-observer variation, specifically in the Bosniak IIF and III categories [2] , [3] , [4] . The confidence in agreement is also experience dependent: ‘The more skilled radiologist the less decrease in confidence with regard to CT or MRI’ [4] , [14] .…”

Section: Discussionmentioning

confidence: 99%

“…The Bosniak classification system (BCS) for cystic renal lesions was developed based on CT findings [1] . The BCS is reader dependent and prone to inter- and intra-reader variations [2] , [3] , [4] . Israel et al [5] showed that the BCS in CT and MRI are similar in most cystic renal lesions.…”

Section: Introductionmentioning

confidence: 99%

A practical guide and decision-making protocol for the management of complex renal cystic masses

Weibl

Hora

Kollarik

et al. 2017

Arab Journal of Urology

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ObjectivesTo analyse the management, pathology and outcomes of complex renal cystic masses (CRCM) and to develop a decision-making tool for daily clinical care using the Bosniak classification system for CRCM.Patients and methodsA comprehensive dataset of 185 patients with 188 CRCM and a minimum follow-up of 3 years were analysed for management, pathology and outcomes.ResultsWe analysed 35 Bosniak II, 34 Bosniak IIF, 58 Bosniak III, and 61 Bosniak IV lesions. The overall incidence of renal cell carcinoma was 8.6%, 29.4%, 62.1%, and 78.7% for each category. Based on our surveillance strategy of Bosniak IIF masses, we recommend computed tomography (CT)/magnetic resonance imaging (MRI) every 2 years after the initial examination. We also recommend performing one MRI (as an adjunct to CT) during the early follow-up period (<4 years). The use of MRI correlation for differential diagnostic purposes has proven useful for marginal Bosniak II, IIF and III cases.ConclusionsFrom our data, we have created a decision-making protocol to guide urologists in planning a safe and effective diagnostic and treatment strategy for CRCM. The Bosniak classification is a useful tool for clinical decision-making. Uncertainties still remain for Bosniak IIF and III lesions. Our protocol shows that individualised decision-making is necessary in a significant proportion of CRCM.

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“…Based on imaging findings, this child's never‐biopsied multiple septated renal cysts are highly likely to be CN, a lesion classically associated with DICER1 mutations . CN usually presents as unilateral single or multiple septated cysts . In DICER1 syndrome, CN develops almost exclusively between birth and age of 4 years …”

Section: Discussionmentioning

confidence: 99%

“…[3,6] CN usually presents as unilateral single or multiple septated cysts. [7] In DICER1 syndrome, CN develops almost exclusively between birth and age of 4 years. [4,6] ASK in carriers of DICER1 mutations appears to represent neoplastic transformation of CN (Fig.…”

Section: Discussionmentioning

confidence: 99%

Evolution of Renal Cysts to Anaplastic Sarcoma of Kidney in a Child With DICER1 Syndrome

Goudie

Druker

et al. 2016

Pediatric Blood & Cancer

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Anaplastic sarcoma of kidney (ASK) is a rare neoplasm recently associated with DICER1 mutations. We report a child with germline DICER1 mutation who developed ASK in preexisting septated renal cysts, which were likely cystic nephroma. From age 2.5 to 6 years, sonographic imaging illustrated changes in the size and number of renal cysts, followed at age 8.8 years by a mass, pathologically an ASK. Lung cysts resected in infancy were diagnosed retrospectively as pleuropulmonary blastoma. Both tumors had acquired somatic DICER1 mutations. Ultrasonographic evolution of renal cysts to ASK has not previously been documented. Children with both pulmonary and renal cysts are candidates for DICER1 mutation testing.

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Bosniak classification system: inter-observer and intra-observer agreement among experienced uroradiologists

Cited by 39 publications

References 25 publications

MRI-based Bosniak Classification of Cystic Renal Masses, Version 2019: Interobserver Agreement, Impact of Readers’ Experience, and Diagnostic Performance

MRI-based Bosniak Classification of Cystic Renal Masses, Version 2019: Interobserver Agreement, Impact of Readers’ Experience, and Diagnostic Performance

A practical guide and decision-making protocol for the management of complex renal cystic masses

Evolution of Renal Cysts to Anaplastic Sarcoma of Kidney in a Child With DICER1 Syndrome

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