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Objectives <p>We aimed to compare Bosniak III and IV cystic renal masses (CRM) using Bosniak classification version 2005 (BC-v2005) versus BC-v2019 and analyze radiological findings and patterns of benignity and malignancy.</p> Methods <p>We retrospectively reviewed all Bosniak III-IV CRMs using BC-v2005 at our center with four-phase CT confirmed pathology, between January 2014 and June 2019. Two radiologists independently re-evaluated each lesion using both BCs, including findings of benignity and malignancy. Bosniak III-IV CRMs were classified in four radiological patterns: inflammatory (CRM-IP), cystic nephroma (CRM-CNP), papillary (CRM-PP), and clear cell (CRM-CCP). Characteristics of patterns were compared.</p> Results <p>Out of 97 patients, 57 Bosniak III-IV CRMs met the inclusion criteria. Twenty-four (42.10%) lesions were reclassified as solid tumours using BC-v2019. Any lesion was downgraded to IIF or lower. Nine (15.78%) lesions were upgraded to Bosniak III-IV CRMs by BC-v2019, despite benign lesions. The presence of acute-angle nodules was the only statistically significant sign of malignancy (<i>p</i> &lt; 0.01). All benign lesions, not considered solid, were included in the two patterns of benignity, characterized by thickened septa and/or wall and without acute-angle nodules. All malignant CRMs presented two patterns of malignancy, proposed as acute-angle nodules. All clear cell carcinomas presented with hyperenhancing acute-angle nodules in the arterial phase. Pattern classification was better for BC-v2005 and BC-v2029, differentiating benign and malignant CRM.</p> Conclusion <p>The proposed four radiological patterns improved performance than BC-v2019 in classifying benign lesions (CRM-IP and CRM-CNP) and malignant ones (CRM-PP and CRM-CCP), with wall and septa thickening and acute-angle nodules as relevant biomarkers.</p>

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Defining new radiological patterns to improve classification of Bosniak III and IV cystic renal masses

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年7月2日

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  • Carmen Sebastià,
  • Lledó Cabedo,
  • Sergio Jiménez-Serrano,
  • Héctor Alfambra,
  • Daniel Corominas,
  • Marc Comas-Cufi,
  • Josep Puig,
  • Carlos Nicolau

摘要

Objectives

We aimed to compare Bosniak III and IV cystic renal masses (CRM) using Bosniak classification version 2005 (BC-v2005) versus BC-v2019 and analyze radiological findings and patterns of benignity and malignancy.

Methods

We retrospectively reviewed all Bosniak III-IV CRMs using BC-v2005 at our center with four-phase CT confirmed pathology, between January 2014 and June 2019. Two radiologists independently re-evaluated each lesion using both BCs, including findings of benignity and malignancy. Bosniak III-IV CRMs were classified in four radiological patterns: inflammatory (CRM-IP), cystic nephroma (CRM-CNP), papillary (CRM-PP), and clear cell (CRM-CCP). Characteristics of patterns were compared.

Results

Out of 97 patients, 57 Bosniak III-IV CRMs met the inclusion criteria. Twenty-four (42.10%) lesions were reclassified as solid tumours using BC-v2019. Any lesion was downgraded to IIF or lower. Nine (15.78%) lesions were upgraded to Bosniak III-IV CRMs by BC-v2019, despite benign lesions. The presence of acute-angle nodules was the only statistically significant sign of malignancy (p < 0.01). All benign lesions, not considered solid, were included in the two patterns of benignity, characterized by thickened septa and/or wall and without acute-angle nodules. All malignant CRMs presented two patterns of malignancy, proposed as acute-angle nodules. All clear cell carcinomas presented with hyperenhancing acute-angle nodules in the arterial phase. Pattern classification was better for BC-v2005 and BC-v2029, differentiating benign and malignant CRM.

Conclusion

The proposed four radiological patterns improved performance than BC-v2019 in classifying benign lesions (CRM-IP and CRM-CNP) and malignant ones (CRM-PP and CRM-CCP), with wall and septa thickening and acute-angle nodules as relevant biomarkers.