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Bosniak Classification for Complex Renal Cysts Reevaluated: A Systematic Review

2017; Lippincott Williams & Wilkins; Volume: 198; Issue: 1 Linguagem: Inglês

10.1016/j.juro.2016.09.160

1527-3792

Ivo G. Schoots, Kèren Zaccai, M. G. Myriam Hunink, Paul C.M.S. Verhagen,

Renal and Vascular Pathologies

No AccessJournal of UrologyReview Article1 Jul 2017Bosniak Classification for Complex Renal Cysts Reevaluated: A Systematic Review Ivo G. Schoots, Keren Zaccai, Myriam G. Hunink, and Paul C.M.S. Verhagen Ivo G. SchootsIvo G. Schoots Department of Radiology and Nuclear Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands , Keren ZaccaiKeren Zaccai Department of Urology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands , Myriam G. HuninkMyriam G. Hunink Department of Radiology and Nuclear Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands Harvard School of Public Health, Harvard University, Department of Health Policy and Management, Boston, Massachusetts , and Paul C.M.S. VerhagenPaul C.M.S. Verhagen Department of Urology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands View All Author Informationhttps://doi.org/10.1016/j.juro.2016.09.160AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We systematically evaluated the Bosniak classification system with malignancy rates of each Bosniak category, and assessed the effectiveness related to surgical treatment and oncologic outcome based on recurrence and/or metastasis. Materials and Methods: In a systematic review according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement and the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies) criteria, we selected 39 publications for inclusion in this analysis and categorized them into 1) surgical cohorts—all cysts treated surgically and 2) radiological cohorts—cysts with surgical treatment or radiological followup. Results: A total of 3,036 complex renal cysts were categorized into Bosniak II, IIF, III and IV. In surgical and radiological cohorts pooled estimates showed a malignancy prevalence of 0.51 (0.44, 0.58) in Bosniak III and 0.89 (0.83, 0.92) in Bosniak IV cysts, respectively. Stable Bosniak IIF cysts showed a malignancy rate of less than 1% during radiological followup (surveillance). Bosniak IIF cysts, which showed reclassification to the Bosniak III/IV category during radiological followup (12%), showed malignancy in 85%, comparable to Bosniak IV cysts. The estimated surgical number needed to treat to avoid metastatic disease of Bosniak III and IV cysts was 140 and 40, respectively. Conclusions: The effectiveness of the Bosniak classification system for complex renal cysts was high in categories II, IIF and IV, but low in category III, and 49% of Bosniak III cysts was overtreated because of a benign outcome. 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Volume 198Issue 1July 2017Page: 12-21Supplementary Materials Advertisement Copyright & Permissions© 2017 by American Urological Association Education and Research, Inc.Keywordskidneyclassificationtreatment outcomecystsnumbers needed to treatAcknowledgmentsW. M. Bramer, medical library information specialist, Erasmus MC University Medical Center, Rotterdam, conducted the systematic literature search, and D. Nieboer, statistician, Erasmus MC University Medical Center, Rotterdam, conducted the statistical analysis.MetricsAuthor Information Ivo G. Schoots Department of Radiology and Nuclear Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands More articles by this author Keren Zaccai Department of Urology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands More articles by this author Myriam G. Hunink Department of Radiology and Nuclear Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands Harvard School of Public Health, Harvard University, Department of Health Policy and Management, Boston, Massachusetts Financial interest and/or other relationship with European Institute for Biomedical Imaging Research, European Society of Radiology and Cambridge University Press. More articles by this author Paul C.M.S. Verhagen Department of Urology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands More articles by this author Expand All Advertisement PDF downloadLoading ...