TY - JOUR
T1 - Bosniak classification of cystic renal masses, version 2019
T2 - An update proposal and needs assessment
AU - Silverman, Stuart G.
AU - Pedrosa, Ivan
AU - Ellis, James H.
AU - Hindman, Nicole M.
AU - Schieda, Nicola
AU - Smith, Andrew D.
AU - Remer, Erick M.
AU - Shinagare, Atul B.
AU - Curci, Nicole E.
AU - Raman, Steven S.
AU - Wells, Shane A.
AU - Kaffenberger, Samuel D.
AU - Wang, Zhen J.
AU - Chandarana, Hersh
AU - Davenport, Matthew S.
N1 - Funding Information:
Disclosures of Conflicts of Interest: S.G.S. disclosed no relevant relationships. I.P. Activities related to the present article: indirectly supported by the National Institutes of Health (grants P50CA196516, R01CA154475, and U01CA207091) in the editing of this article. Activities not related to the present article: is on the speakers bureau of Dava Oncology. Other relationships: disclosed no relevant relationships. J.H.E. disclosed no relevant relationships. N.M.H. disclosed no relevant relationships. N.S. disclosed no relevant relationships. A.D.S. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: institution has a grant pending with GE Healthcare; has multiple patents issued and pending on image software processing algorithms that are unrelated to this topic; receives royalty fee for eMASS software; is the president of Radiostics, eMASS, Liver Nodularity, and Color Enhanced Detection; has patents pending for eMASS and Liver Nodularity; has been issued patents for eMASS, Liver Nodularity, and Color Enhanced Detection; receives royalties from licensing through eMASS. Other relationships: disclosed no relevant relationships. E.M.R. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: has received travel support from Bracco Group for the Society of Abdominal Radiology Igor Laufer Visiting Professorship. Other relationships: disclosed no relevant relationships. A.B.S. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: is a consultant for Arog Pharmaceuticals; has received research funding from GTx. Other relationships: disclosed no relevant relationships. N.E.C. disclosed no relevant relationships. S.S.R. disclosed no relevant relationships. S.A.W. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: is a consultant for Ethicon. Other relationships: disclosed no relevant relationships. S.D.K. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: was a consultant for MDHx Health in 2017 and a consultant for Clovis Oncology in 2018. Other relationships: disclosed no relevant relationships. Z.J.W. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: holds stock or stock options in Nextrast. Other relationships: disclosed no relevant relationships. H.C. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: along with institution, has filed two patents not related to the current work (one for an MRI technique called GRASP; one for the automated evaluation of image quality using machine learning). No royalties have yet been received. Institution has received research support in the form of hardware and software from Siemens Healthineers. Other relationships: disclosed no relevant relationships. M.S.D. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: receives royalties from Wolters Kluwer for a core review book. Other relationships: disclosed no relevant relationships.
Publisher Copyright:
© RSNA, 2019.
PY - 2019
Y1 - 2019
N2 - Cystic renal cell carcinoma (RCC) is almost certainly overdiagnosed and overtreated. Efforts to diagnose and treat RCC at a curable stage result in many benign neoplasms and indolent cancers being resected without clear benefit. This is especially true for cystic masses, which compared with solid masses are more likely to be benign and, when malignant, less aggressive. For more than 30 years, the Bosniak classification has been used to stratify the risk of malignancy in cystic renal masses. Although it is widely used and still effective, the classification does not formally incorporate masses identified at MRI or US or masses that are incompletely characterized but are highly likely to be benign, and it is affected by interreader variability and variable reported malignancy rates. The Bosniak classification system cannot fully differentiate aggressive from indolent cancers and results in many benign masses being resected. This proposed update to the Bosniak classification addresses some of these shortcomings. The primary modifications incorporate MRI, establish definitions for previously vague imaging terms, and enable a greater proportion of masses to enter lower-risk classes. Although the update will require validation, it aims to expand the number of cystic masses to which the Bosniak classification can be applied while improving its precision and accuracy for the likelihood of cancer in each class.
AB - Cystic renal cell carcinoma (RCC) is almost certainly overdiagnosed and overtreated. Efforts to diagnose and treat RCC at a curable stage result in many benign neoplasms and indolent cancers being resected without clear benefit. This is especially true for cystic masses, which compared with solid masses are more likely to be benign and, when malignant, less aggressive. For more than 30 years, the Bosniak classification has been used to stratify the risk of malignancy in cystic renal masses. Although it is widely used and still effective, the classification does not formally incorporate masses identified at MRI or US or masses that are incompletely characterized but are highly likely to be benign, and it is affected by interreader variability and variable reported malignancy rates. The Bosniak classification system cannot fully differentiate aggressive from indolent cancers and results in many benign masses being resected. This proposed update to the Bosniak classification addresses some of these shortcomings. The primary modifications incorporate MRI, establish definitions for previously vague imaging terms, and enable a greater proportion of masses to enter lower-risk classes. Although the update will require validation, it aims to expand the number of cystic masses to which the Bosniak classification can be applied while improving its precision and accuracy for the likelihood of cancer in each class.
UR - http://www.scopus.com/inward/record.url?scp=85070114574&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85070114574&partnerID=8YFLogxK
U2 - 10.1148/radiol.2019182646
DO - 10.1148/radiol.2019182646
M3 - Article
C2 - 31210616
AN - SCOPUS:85070114574
SN - 0033-8419
VL - 292
SP - 475
EP - 488
JO - RADIOLOGY
JF - RADIOLOGY
IS - 2
ER -