Purpose:The follow-up of Bosniak IIF renal cysts is associated with significant costs, radiation, and anxiety. Recent studies have suggested a risk of malignancy and upgrading lower than previously reported. We aimed to determine their clinical outcomes and to evaluate the impact of the 2019 Bosniak classification on the diagnosis of such lesions.Materials and Methods:We identified all radiology reports with the diagnosis of a Bosniak IIF cyst at our institution between January 2000 and December 2018. Imaging was reviewed to confirm the diagnosis and determine progression based on the 2005 Bosniak classification. Radiological and clinical characteristics were established, and the 2019 Bosniak criteria were retrospectively applied.Results:Out of 252 cysts reviewed, 55 (22%) were reclassified as Bosniak II upon revision using the 2005 Bosniak classification. A total of 181 Bosniak IIF cysts were included for final analysis. The median imaging follow-up was 50 months. Four (2.2%) cysts progressed to Bosniak III or IV. Five (2.8%) patients underwent surgical interventions, with only 1 malignant pathology being reported. No malignant progression was observed after 36 months. When applied to our cohort, the 2019 Bosniak classification would have led to a 76% decrease in Bosniak IIF diagnoses, with no increase in Bosniak III or IV diagnoses, and identical classification of the confirmed malignant pathology.Conclusions:Upgrading and malignancy rates among Bosniak IIF cysts was markedly lower than traditionally reported. No patient had a significant progression beyond 36 months. More than 20% of Bosniak IIF cysts were initially overdiagnosed. The 2019 Bosniak classification may help to reduce the overdiagnosis of Bosniak IIF lesions requiring follow-up.
INTRODUCTION AND OBJECTIVE:The follow-up of Bosniak BIIF renal cysts is associated with significant costs, radiation, and anxiety. Recent studies suggest a risk of malignancy and upgrading lower than previously reported. New radiological definitions of the Bosniak categories have been introduced in 2019. We aimed to determine the radiological and clinical evolution of BIIF cysts diagnosed at our institution and to establish the impact of the 2019 Bosniak classification on the diagnosis of such lesions.METHODS: We identified all radiology reports with the diagnosis of a BIIF cyst at our institution between January 2000 and December 2018. Diagnostic and follow-up imaging was reviewed by trained radiologists to confirm the diagnosis and determine progression. Radiological and clinical characteristics were established, and the 2019 Bosniak criteria were retrospectively applied.RESULTS: Out of 252 cysts initially reviewed, 55 (22%) were re-classified as BII upon revision. A total of 181 BIIF cysts were included for final analysis. The median imaging follow-up was 50 months. Only 4 (2%) cysts progressed to BIII or BIV. Five (3%) patients underwent surgical interventions, with only one malignant pathology being reported. No patient had a radiological progression without a confirmed benign pathology beyond 36 months. When applied to our cohort, the 2019 Bosniak classification would have led to a 76% decrease in BIIF diagnoses, with no increase in BIII or BIIV diagnoses, and identical classification of the confirmed malignant pathology.CONCLUSIONS: The rate of upgrading and malignancy among BIIF renal cysts was markedly lower than traditionally reported. No patient had a significant progression beyond 36 months. More than 20% of BIIF cysts were initially overdiagnosed by radiologists. The 2019 Bosniak classification may help to reduce the overdiagnosis of BIIF lesions requiring follow-up, avoiding important costs/harm to patients.
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