Julia Slotta-Huspenina1, Konrad Friedrich Stock2, Elena Herms3, Gregor Weirich1, Tobias Maurer4, Stefan Wagenpfeil5, Stephanie Preuss3, Andreas Sauter6, Matthias Heck7, Anita Gärtner8, Katharina Hauner7, Michael Autenrieth7, Hubert P Kübler9, Konstantin Holzapfel10, Ulrike Schwarz-Boeger11, Uwe Heemann3. 1. Institute of Pathology, University Hospital MRI-TUM (München Rechts Der Isar), Munich, Germany. 2. Department of Nephrology, University Hospital MRI-TUM (München Rechts Der Isar), Munich, Germany. Konrad.Stock@mri.tum.de. 3. Department of Nephrology, University Hospital MRI-TUM (München Rechts Der Isar), Munich, Germany. 4. Department of Urology and Martini-Klinik, University Hospital Hamburg-Eppendorf, Hamburg, Germany. 5. Institute of Medical Biometry, Epidemiology and Medical Informatics (IMBEI), Saarland University, Campus Homburg, Homburg, Germany. 6. Department of Radiology, University Hospital MRI-TUM (München Rechts Der Isar), Munich, Germany. 7. Department of Urology, University Hospital MRI-TUM (München Rechts Der Isar), Munich, Germany. 8. Department of Anesthesia, Freising University Hospital, Freising, Germany. 9. Department of Urology, University Hospital Würzburg, Würzburg, Germany. 10. Department of Radiology, Hospital Landshut-Achdorf, Landshut, Germany. 11. Medical Controlling, University Hospital MRI-TUM (München Rechts Der Isar), Munich, Germany.
Abstract
PURPOSE: Renal cysts comprise benign and malignant entities. Risk assessment profits from CT/MRI imaging using the Bosniak classification. While Bosniak-IIF, -III, and -IV cover complex cyst variants, Bosniak-IIF and -III stand out due to notorious overestimation. Contrast-enhanced ultrasound (CEUS) is promising to overcome this deficit but warrants standardization. This study addresses the benefits of a combined CEUS and CT/MRI evaluation of renal cysts. The study provides a realistic account of kidney tumor boards' intricacies in trying to validate renal cysts. METHODS: 247 patients were examined over 8 years. CEUS lesions were graded according to CEUS-Bosniak (IIF, III, IV). 55 lesions were resected, CEUS-Bosniak- and CT/MRI-Bosniak-classification were correlated with histopathological diagnosis. Interobserver agreement between the classifications was evaluated statistically. 105 lesions were followed by ultrasound, and change in CEUS-Bosniak-types and lesion size were documented. RESULTS: 146 patients (156 lesions) were included. CEUS classified 67 lesions as CEUS-Bosniak-IIF, 44 as CEUS-Bosniak-III, and 45 as CEUS-Bosniak-IV. Histopathology of 55 resected lesions revealed benign cysts in all CEUS-Bosniak-IIF lesions (2/2), 40% of CEUS-Bosniak-III and 8% of CEUS-Bosniak-IV, whereas malignancy was uncovered in 60% of CEUS-Bosniak-III and 92% of CEUS-Bosniak-IV. Overall, CEUS-Bosniak-types matched CT/MRI-Bosniak types in 58% (fair agreement, κ = 0.28). CEUS-Bosniak resulted in higher stages than CT/MRI-Bosniak (40%). Ultrasound follow-up of 105 lesions detected no relevant differences between CEUS-Bosniak-types concerning cysts size. 99% of lesions showed the same CEUS-Bosniak-type. CONCLUSION: The CEUS-Bosniak classification is an essential tool in clinical practice to differentiate and monitor renal cystic lesions and empowers diagnostic work-up and patient care.
PURPOSE: Renal cysts comprise benign and malignant entities. Risk assessment profits from CT/MRI imaging using the Bosniak classification. While Bosniak-IIF, -III, and -IV cover complex cyst variants, Bosniak-IIF and -III stand out due to notorious overestimation. Contrast-enhanced ultrasound (CEUS) is promising to overcome this deficit but warrants standardization. This study addresses the benefits of a combined CEUS and CT/MRI evaluation of renal cysts. The study provides a realistic account of kidney tumor boards' intricacies in trying to validate renal cysts. METHODS: 247 patients were examined over 8 years. CEUS lesions were graded according to CEUS-Bosniak (IIF, III, IV). 55 lesions were resected, CEUS-Bosniak- and CT/MRI-Bosniak-classification were correlated with histopathological diagnosis. Interobserver agreement between the classifications was evaluated statistically. 105 lesions were followed by ultrasound, and change in CEUS-Bosniak-types and lesion size were documented. RESULTS: 146 patients (156 lesions) were included. CEUS classified 67 lesions as CEUS-Bosniak-IIF, 44 as CEUS-Bosniak-III, and 45 as CEUS-Bosniak-IV. Histopathology of 55 resected lesions revealed benign cysts in all CEUS-Bosniak-IIF lesions (2/2), 40% of CEUS-Bosniak-III and 8% of CEUS-Bosniak-IV, whereas malignancy was uncovered in 60% of CEUS-Bosniak-III and 92% of CEUS-Bosniak-IV. Overall, CEUS-Bosniak-types matched CT/MRI-Bosniak types in 58% (fair agreement, κ = 0.28). CEUS-Bosniak resulted in higher stages than CT/MRI-Bosniak (40%). Ultrasound follow-up of 105 lesions detected no relevant differences between CEUS-Bosniak-types concerning cysts size. 99% of lesions showed the same CEUS-Bosniak-type. CONCLUSION: The CEUS-Bosniak classification is an essential tool in clinical practice to differentiate and monitor renal cystic lesions and empowers diagnostic work-up and patient care.
Authors: Vito Cantisani; Michele Bertolotto; Dirk-André Clevert; Jean-Michel Correas; Francesco Maria Drudi; Thomas Fischer; Odd Helge Gilja; Antonio Granata; Ole Graumann; Christopher J Harvey; Andre Ignee; Christian Jenssen; Markus Herbert Lerchbaumer; Matthew Ragel; Adrian Saftoiu; Andreas L Serra; Konrad Friedrich Stock; Jolanta Webb; Paul S Sidhu Journal: Ultraschall Med Date: 2020-12-11 Impact factor: 6.548
Authors: Marwa F Ismail; Gideon M Hirschfield; Bettina Hansen; Monica Tafur; Khaled Y Elbanna; Marc H Goldfinger; Gerard R Ridgway; Kartik S Jhaveri Journal: Eur Radiol Date: 2021-07-06 Impact factor: 5.315