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

Bai, Xu; Sun, Song-Mei; Wang, Xu; Kang, Huanhuan; Li, Lin; Jin, Ye-Qiang; Gong, Qing-Ge-Le; Liang, Guo-Cheng; Liu, Hongyan; Liu, Linlin; Chen, Silu; Wang, Qingrong; Wu, Ping; Guo, Aitao; Huang, Qingbo; Zhang, Xiaojing; Ye, Huiyi; Wang, Haiyi

doi:10.1148/radiol.2020200478

Cited by 48 publications

(34 citation statements)

References 23 publications

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“…Preliminary studies evaluating interobserver agreement while using Bosniak Classification, version 2019 show moderate (MRI) to substantial (CT and MRI) agreement between readers. However, data are limited by a small sample size (11,12,15) Lack of explicit definitions for imaging terms and features contributed to a third shortcoming: widely variable reported malignancy rates for each of the Bosniak classes (4-7). A fourth shortcoming of the original classification was that MRI and US were not fully incorporated.…”

Section: Imaging Techniques For Evaluation Of Cystic Renal Masses General Imaging Techniquementioning

confidence: 99%

Bosniak Classification of Cystic Renal Masses, Version 2019: A Pictorial Guide to Clinical Use

Schieda¹,

Davenport²,

Krishna³

et al. 2021

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Cystic renal masses are commonly encountered in clinical practice. In 2019, the Bosniak classification of cystic renal masses, originally developed for CT, underwent a major revision to incorporate MRI and is referred to as the Bosniak Classification, version 2019. The proposed changes attempt to (a) define renal masses (ie, cystic tumors with less than 25% enhancing tissue) to which the classification should be applied; (b) emphasize specificity for diagnosis of cystic renal cancers, thereby decreasing the number of benign and indolent cystic masses that are unnecessarily treated or imaged further; (c) improve interobserver agreement by defining imaging features, terms, and classes of cystic renal masses; (d) reduce variation in reported malignancy rates for each of the Bosniak classes; (e) incorporate MRI and to some extent US; and (f) be applicable to all cystic renal masses encountered in clinical practice, including those that had been considered indeterminate with the original classification. The authors instruct how, using CT, MRI, and to some extent US, the revised classification can be applied, with representative clinical examples and images. Practical tips, pitfalls to avoid, and decision tree rules are included to help radiologists and other physicians apply the Bosniak Classification, version 2019 and better manage cystic renal masses. An online resource and mobile application are also available for clinical assistance.

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Section: Imaging Techniques For Evaluation Of Cystic Renal Masses General Imaging Techniquementioning

confidence: 99%

Bosniak Classification of Cystic Renal Masses, Version 2019: A Pictorial Guide to Clinical Use

Schieda¹,

Davenport²,

Krishna³

et al. 2021

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“…In our study, intra-observer agreement was similar for both systems within readers and the degree of agreement between the two systems did not substantially change at either session for any reader. A moderate level of agreement using Bosniak classification has been reported previously using both the original and v2019 systems (3,8). This level of agreement is not optimal; however, implications on clinical care are not directly correlated to agreement.…”

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confidence: 68%

“…Among many changes, Bosniak.v2019 aims to improve inter-observer agreement compared to Bosniak.original through rigorous definitions of imaging features and Bosniak classes (1). Preliminary studies comparing inter-observer agreement between the two classification systems published to date have shown either no difference or only modest improvement (2)(3)(4). Recently published support aids for use of Bosniak.v2019, including diagrammatic and online decision support aim to simplify use of Bosniak.v2019 (5) but the impact of these decision support aids have not yet been determined.…”

Section: Introductionmentioning

confidence: 99%

Inter-observer and intra-observer agreement of Bosniak classification of cystic renal masses: Comparison between original version to version 2019 and effect of an online support calculator

Osman

Yan

Chan

et al. 2021

CUAJ

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Osman et al Original vs. 2019 version of Bosniak classification of cystic renal masses 2 © 2021 Canadian Urological Association MethodsThis IRB approved cross-sectional study evaluated 103 consecutively identified cystic (≤25% enhancing (1)) masses: 70.9% (73/103) with pathological confirmation (80.8% [59/73] malignant, 19.2% [14/73] benign), and 29.1% (30/103) Bosniak 2/2F masses classified by an expert genitourinary radiologist each with minimum 5 years stability on follow-up (1); the latter group added to balance distribution of cystic masses among the Bosniak categories, Figure 1. Cystic masses were identified through a PACS and pathology database search for the term 'Bosniak' between 2010-2020. All masses were imaged with renal protocol CT or MRI. For patients with both CT and MRI, MRI was evaluated since MRI is known to result in a higher Bosniak class (6). A portion of the study population has been evaluated previously [BLINDED]; however, the purpose of specifically comparing agreement between the two systems over time with and without use of a support calculator has not been previously studied.Three blinded fellowship-trained abdominal radiologists (R2-R4, years of experience 5-8) independently assigned Bosniak.original Class first and then Bosniak.v2019 Class second during one session. After a ≥2-month washout period, R2-R4 re-assigned Bosniak.original and Bosniak.v2019 Class during a second session. Before the second session, radiologists were provided with a pictorial review of the Bosniak.v2019 system, decision support flow diagrams (5) and an on-line support calculator developed for Bosniak.v2019 (bosniakcalculator.herokuapp.com). The radiologists jointly trialed the calculator using 5 test cases in conjunction with R1. Inter-observer and intra-observer agreement were calculated using Cohen's Kappa and agreement between Bosniak.original and Bosniak.v2019 was also calculated for both sessions. Kappa values of 0-2.0 indicated slight agreement, 2.1-4.0 fair agreement, 4.1-6.0 moderate agreement, 6.1-8.0 substantial agreement and 8.1-1.0 almost perfect agreement. ResultsA summary of inter-observer and intra-observer agreement, using Bosniak.original and Bosniak.v2019 is provided in Table 1. In the first session, marginally higher moderate interobserver agreement was noted comparing Bosniak.v2019 (K=0.44) to Bosniak.original (K=0.39). There was no change in inter-observer agreement comparing Bosniak.v2019 classification with (K=0.42) or without the on-line calculator (K=0.44). Comparatively, interobserver agreement for Bosniak.original decreased in the second session (K=0.25). Within reader intra-observer agreement was similar for both Bosniak.orginal and Bosniak.v2019 and within reader level of agreement comparing class designation using Bosniak.original and Bosniak.v2019 was also similar for both sessions, Table 2. CUAJ -ResearchLetter Osman et al Original vs. 2019 version of Bosniak classification of cystic renal masses 3 © 2021 Canadian Urological Association DiscussionBosniak.v2019 presents a major r...

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“…While the Bosniak classification was originally developed for contrast-enhanced CT, the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) proposed a CEUS-adapted Bosniak categorization system in 2020 in order to overcome differences in imaging specifics and improve the diagnostic accuracy of CEUS in characterizing cystic renal lesions [33]. A recent study evaluating the impact of the updated Bosniak classification in MRI demonstrated higher interobserver agreement and higher diagnostic accuracy when using the updated version [34]. All in all, the Bosniak classification system is a useful tool to make radiologic reporting more standardized and structured, thus facilitating further patient management.…”

Section: Discussionmentioning

confidence: 99%

Structured Reporting in the Characterization of Renal Cysts by Contrast-Enhanced Ultrasound (CEUS) Using the Bosniak Classification System—Improvement of Report Quality and Interdisciplinary Communication

et al. 2021

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Background: This study aims to evaluate the potential benefits of structured reporting (SR) compared to conventional free-text reporting (FTR) in contrast-enhanced ultrasound (CEUS) of cystic renal lesions, based on the Bosniak classification. Methods: Fifty patients with cystic renal lesions who underwent CEUS were included in this single-center study. FTR created in clinical routine were compared to SR retrospectively generated by using a structured reporting template. Two experienced urologists evaluated the reports regarding integrity, effort for information extraction, linguistic quality, and overall quality. Results: The required information could easily be extracted by the reviewers in 100% of SR vs. 82% of FTR (p < 0.001). The reviewers trusted the information given by SR significantly more with a mean of 5.99 vs. 5.52 for FTR (p < 0.001). SR significantly improved the linguistic quality (6.0 for SR vs. 5.68 for FTR (p < 0.001)) and the overall report quality (5.98 for SR vs. 5.58 for FTR (p < 0.001)). Conclusions: SR significantly increases the quality of radiologic reports in CEUS examinations of cystic renal lesions compared to conventional FTR and represents a promising approach to facilitate interdisciplinary communication in the future.

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

Cited by 48 publications

References 23 publications

Bosniak Classification of Cystic Renal Masses, Version 2019: A Pictorial Guide to Clinical Use

Bosniak Classification of Cystic Renal Masses, Version 2019: A Pictorial Guide to Clinical Use

Inter-observer and intra-observer agreement of Bosniak classification of cystic renal masses: Comparison between original version to version 2019 and effect of an online support calculator

Structured Reporting in the Characterization of Renal Cysts by Contrast-Enhanced Ultrasound (CEUS) Using the Bosniak Classification System—Improvement of Report Quality and Interdisciplinary Communication

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