Outcomes and Complications Related to the Management of Bosniak Cystic Renal Lesions

Smith, Andrew D.; Allen, Brian C.; Sanyal, Rupan; Carson, James D.; Zhang, Haowei; Williams, Joseph; Collins, C.; Griswold, Michael; Zhang, Xu

doi:10.2214/ajr.14.13149

Cited by 56 publications

(44 citation statements)

References 22 publications

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“…We varied the sex, age (60-80 years at the time of detection), and comorbidity levels (none, mild, moderate, and severe) of hypothetical patient cohorts with these low-risk incidental findings to determine how these patient-level factors affect LE benefit of follow-up (14). We focused on these specific findings because their established risk of malignancy may not be high enough to warrant routine follow-up in all clinical settings (13,(15)(16)(17)(18)(19)(20)(21)(22)(23). For clarity, we describe our model assumptions and analysis for Bosniak IIF renal cysts here, and address modifications relevant to SBIPMNs in Appendix E1 (online).…”

Section: Methodsmentioning

confidence: 99%

“…Patients who underwent imaging follow-up did so for 5 years, as is typical for Bosniak IIF renal cysts (3,13). These patients were spared of RCC-specific mortality risks because we assumed that Bosniak IIF-related RCC would be identified and successfully treated during follow-up (19,21). In the event that another cancer of the same cell type developed during follow-up (ie, a separate RCC), we similarly assumed that it would be detected and successfully treated.…”

Section: Gastrointestinal Imaging: Imaging Follow-up Of Low-risk Incimentioning

confidence: 99%

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Imaging Follow-up of Low-Risk Incidental Pancreas and Kidney Findings: Effects of Patient Age and Comorbidity on Projected Life Expectancy

et al. 2018

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Purpose To determine the effects of patient age and comorbidity level on life expectancy (LE) benefits associated with imaging follow-up of Bosniak IIF renal cysts and pancreatic side-branch (SB) intraductal papillary mucinous neoplasms (IPMNs). Materials and Methods A decision-analytic Markov model to evaluate LE benefits was developed. Hypothetical cohorts with varied age (60-80 years) and comorbidities (none, mild, moderate, or severe) were evaluated. For each finding, LE projections from two strategies were compared: imaging follow-up and no imaging follow-up. Under follow-up, it was assumed that cancers associated with the incidental finding were successfully treated before they spread. For patients without follow-up, mortality risks from Bosniak IIF cysts (renal cell carcinoma) and SBIPMNs (pancreatic ductal adenocarcinoma) were incorporated. Model assumptions and parameter uncertainty were evaluated in sensitivity analysis. Results In the youngest, healthiest cohorts (age, 60 years; no comorbidities), projected LE benefits from follow-up were as follows: Bosniak IIF cyst, 6.5 months (women) and 5.8 months (men); SBIPMN, 6.4 months (women) and 5.3 months (men). Follow-up of Bosniak IIF cysts in 60-year-old women with severe comorbidities yielded a LE benefit of 3.9 months; in 80-year-old women with no comorbidities, the benefit was 2.8 months, and with severe comorbidities the benefit was 1.5 months. Similar trends were observed in men and for SBIPMN. Results were sensitive to the performance of follow-up for cancer detection; malignancy risks; and stage at presentation of malignant, unfollowed Bosniak IIF cysts. Conclusion With progression of age and comorbidity level, follow-up of low-risk incidental findings yields increasingly limited benefits for patients. RSNA, 2018 Online supplemental material is available for this article.

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Section: Methodsmentioning

confidence: 99%

Section: Gastrointestinal Imaging: Imaging Follow-up Of Low-risk Incimentioning

confidence: 99%

Imaging Follow-up of Low-Risk Incidental Pancreas and Kidney Findings: Effects of Patient Age and Comorbidity on Projected Life Expectancy

et al. 2018

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“…The modified Bosniak radiological classification is an immensely useful tool for surgical decision making pertaining to patients at risk of renal cystic neoplasia. Historically, it has been estimated that between 5 and 10% of cases of renal cancer originate from renal cystic pathology [8,9]. Recently, an update to the Bosniak classification was proposed, with the addition of MRI criteria, with an intention to improve the ability of the original classification to predict the likelihood of malignancy in a cystic renal lesion [10].…”

Section: Discussionmentioning

confidence: 99%

Clinical Correlation Between Computerized Tomography Findings and Pathologic Diagnosis in Patients Surgically Treated for Complex Renal Cysts in a Colombian Tertiary Center

Castañeda-Millán¹,

Barros-Valderrama²,

Camacho-Nieto³

et al. 2019

Cureus

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IntroductionRecent data have reexamined the historical rates of malignancy observed in Bosniak IIF and III cystic lesions, and this has led to an endorsement of the use of active surveillance as the standard of care for Bosniak III renal cysts by affirming that overtreatment rates for this subgroup are close to 50%. In light of this, the present study describes the correlation between imaging studies and pathologic diagnosis in patients surgically treated for complex renal cysts in Colombia.Materials and methodsThis is a retrospective, descriptive, and observational study. We analyzed the medical histories of patients who had been surgically treated for complex renal cysts between 2010 and 2018 in the urology department of a tertiary center in Bogota, Colombia. The exclusion criteria were incomplete clinical histories and absent diagnostic images or their official interpretation.ResultsOut of the 235 urological procedures performed, nine were excluded. And 6.19% (n = 14) were cases of surgically treated complex renal cysts; 38.46% were compatible with Bosniak IIF, 46.15% were Bosniak III, and 15.38% were Bosniak IV. The percentage of renal cancer as revealed by the histopathological study was 60, 66.7 and 100 for renal cysts Bosniak IIF, III, and IV, respectively; 77.7% of these confirmed oncological cases had received a diagnosis of clear cell renal carcinoma.ConclusionsIn our study, the percentage of malignancy in patients with renal cysts Bosniak IIF and III was found to be greater compared to the findings in the recent medical literature. We believe that the management offered to the population with complex renal cysts in Colombia should be tailored to the individual risk characteristics of each patient.

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“…The purpose of imaging surveillance is to identify Bosniak 2F renal cysts that progress to higher-category lesions, because upward reclassification is associated with an increased malignancy rate. The malignancy rate of upward reclassification ranges from 5% to 16% and typically occurs in the first 2 years after diagnosis [18]. However, the malignancies in Bosniak 2F cysts are in general of low grade and stage and prognosis is excellent.…”

Section: Discussionmentioning

confidence: 99%

Algorithm for Bosniak 2F Cyst in Kidney Donation

et al. 2017

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Patient: Female, 54Final Diagnosis: Multilocular cystic renal cell carcinoma with clear cellsSymptoms: NoneMedication: —Clinical Procedure: Hand-assisted retroperitoneal donor nephrectomySpecialty: TransplantologyObjective:Unusual setting of medical careBackground:The Bosniak system for radiological classification of renal cysts offers a tool for surgical decision-making in clinical practice. Although 95% of Bosniak 2F cysts remain benign, a consensus on the management of Bosniak 2F cysts in kidney donation has not been developed.Case Report:We present a donor with a Bosniak 2F cyst, who successfully donated her kidney after partial resection of the Bosniak 2F cyst. Postoperative pathology examination of the partially resected cystic wall revealed a multilocular cystic renal cell carcinoma. Postoperative pathology examination revealed a multilocular cystic renal cell carcinoma. Resection of the Bosniak 2F cyst provides 2 advantages: the recipient receives a new donor kidney and will be free of dialysis, and the donor will be free of surveillance.Conclusions:We present a practical guideline for kidney donors with Bosniak 2F cysts, balancing the risk of tumor transmission or recurrence with the benefit associated with organ transplantation, without compromising the risk of the donor and recipient. Further evaluation of this algorithm by longer follow-up and more studies is needed to prove its safety.

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Outcomes and Complications Related to the Management of Bosniak Cystic Renal Lesions

Abstract: There were no deaths from Bosniak IIF or III renal cysts regardless of management approach. Moderate to severe complications are frequent in patients managed by surgery.

Cited by 56 publications

References 22 publications

Imaging Follow-up of Low-Risk Incidental Pancreas and Kidney Findings: Effects of Patient Age and Comorbidity on Projected Life Expectancy

Imaging Follow-up of Low-Risk Incidental Pancreas and Kidney Findings: Effects of Patient Age and Comorbidity on Projected Life Expectancy

Clinical Correlation Between Computerized Tomography Findings and Pathologic Diagnosis in Patients Surgically Treated for Complex Renal Cysts in a Colombian Tertiary Center

Algorithm for Bosniak 2F Cyst in Kidney Donation

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