Jérémy Dana1,2,3, Simon Gauvin1,4, Michelle Zhang1,4, Jose Lotero1, Christopher Cassim1, Giovanni Artho1,4, Sahir Rai Bhatnagar1,5, Simon Tanguay6, Caroline Reinhold7,8,9. 1. Department of Diagnostic Radiology, McGill University Health Center, 1001 Decarie Boul., H4A 3J1, Montréal, Québec, Canada. 2. Strasbourg University, Inserm U1110, Institut de Recherche sur les Maladies Virales et Hépatiques, Strasbourg, France. 3. IHU-Strasbourg (Institut Hospitalo-Universitaire), Institute for Minimally Invasive Hybrid Image-Guided Surgery, Université de Strasbourg, Strasbourg, France. 4. Montreal Imaging Experts Inc., Montreal, Canada. 5. Department of Epidemiology, Biostatistics and Occupational Health, McGill University Health Center, Montréal, Québec, Canada. 6. Department of Urology, McGill University Health Center, Montréal, Québec, Canada. 7. Department of Diagnostic Radiology, McGill University Health Center, 1001 Decarie Boul., H4A 3J1, Montréal, Québec, Canada. caroline.reinhold@mcgill.ca. 8. Montreal Imaging Experts Inc., Montreal, Canada. caroline.reinhold@mcgill.ca. 9. Augmented Intelligence & Precision Health Laboratory of the Research Institute of McGill University Health Centre, Montreal, Canada. caroline.reinhold@mcgill.ca.
Abstract
OBJECTIVE: To compare the diagnostic performance and inter-reader agreement of the CT-based v2019 versus v2005 Bosniak classification systems for risk stratification of cystic renal lesions (CRL). METHODS: This retrospective study included adult patients with CRL identified on CT scan between 2005 and 2018. The reference standard was histopathology or a minimum 4-year imaging follow-up. The studies were reviewed independently by five readers (three senior, two junior), blinded to pathology results and imaging follow-up, who assigned Bosniak categories based on the 2005 and 2019 versions. Diagnostic performance of v2005 and v2019 Bosniak classifications for distinguishing benign from malignant lesions was calculated by dichotomizing CRL into the potential for ablative therapy (III-IV) or conservative management (I-IIF). Inter-reader agreement was calculated using Light's Kappa. RESULTS: One hundred thirty-nine patients with 149 CRL (33 malignant) were included. v2005 and v2019 Bosniak classifications achieved similar diagnostic performance with a sensitivity of 91% vs 91% and a specificity of 89% vs 88%, respectively. Inter-reader agreement for overall Bosniak category assignment was substantial for v2005 (κ = 0.78) and v2019 (κ = 0.75) between senior readers but decreased for v2019 when the Bosniak classification was dichotomized to conservative management (I-IIF) or ablative therapy (III-IV) (0.80 vs 0.71, respectively). For v2019, wall thickness was the morphological feature with the poorest inter-reader agreement (κ = 0.43 and 0.18 for senior and junior readers, respectively). CONCLUSION: No significant improvement in diagnostic performance and inter-reader agreement was shown between v2005 and v2019. The observed decrease in inter-reader agreement in v2019 when dichotomized according to management strategy may reflect the more stringent morphological criteria. KEY POINTS: • Versions 2005 and 2019 Bosniak classifications achieved similar diagnostic performance, but the specificity of higher risk categories (III and IV) was not increased while one malignant lesion was downgraded to v2019 Bosniak category II (i.e., not subjected to further follow-up). • Inter-reader agreement was similar between v2005 and v2019 but moderately decreased for v2019 when the Bosniak classification was dichotomized according to the potential need for ablative therapies (I-II-IIF vs III-IV).
OBJECTIVE: To compare the diagnostic performance and inter-reader agreement of the CT-based v2019 versus v2005 Bosniak classification systems for risk stratification of cystic renal lesions (CRL). METHODS: This retrospective study included adult patients with CRL identified on CT scan between 2005 and 2018. The reference standard was histopathology or a minimum 4-year imaging follow-up. The studies were reviewed independently by five readers (three senior, two junior), blinded to pathology results and imaging follow-up, who assigned Bosniak categories based on the 2005 and 2019 versions. Diagnostic performance of v2005 and v2019 Bosniak classifications for distinguishing benign from malignant lesions was calculated by dichotomizing CRL into the potential for ablative therapy (III-IV) or conservative management (I-IIF). Inter-reader agreement was calculated using Light's Kappa. RESULTS: One hundred thirty-nine patients with 149 CRL (33 malignant) were included. v2005 and v2019 Bosniak classifications achieved similar diagnostic performance with a sensitivity of 91% vs 91% and a specificity of 89% vs 88%, respectively. Inter-reader agreement for overall Bosniak category assignment was substantial for v2005 (κ = 0.78) and v2019 (κ = 0.75) between senior readers but decreased for v2019 when the Bosniak classification was dichotomized to conservative management (I-IIF) or ablative therapy (III-IV) (0.80 vs 0.71, respectively). For v2019, wall thickness was the morphological feature with the poorest inter-reader agreement (κ = 0.43 and 0.18 for senior and junior readers, respectively). CONCLUSION: No significant improvement in diagnostic performance and inter-reader agreement was shown between v2005 and v2019. The observed decrease in inter-reader agreement in v2019 when dichotomized according to management strategy may reflect the more stringent morphological criteria. KEY POINTS: • Versions 2005 and 2019 Bosniak classifications achieved similar diagnostic performance, but the specificity of higher risk categories (III and IV) was not increased while one malignant lesion was downgraded to v2019 Bosniak category II (i.e., not subjected to further follow-up). • Inter-reader agreement was similar between v2005 and v2019 but moderately decreased for v2019 when the Bosniak classification was dichotomized according to the potential need for ablative therapies (I-II-IIF vs III-IV).
Authors: Stuart G Silverman; Ivan Pedrosa; James H Ellis; Nicole M Hindman; Nicola Schieda; Andrew D Smith; Erick M Remer; Atul B Shinagare; Nicole E Curci; Steven S Raman; Shane A Wells; Samuel D Kaffenberger; Zhen J Wang; Hersh Chandarana; Matthew S Davenport Journal: Radiology Date: 2019-06-18 Impact factor: 11.105
Authors: Sabina Sevcenco; Claudio Spick; Thomas H Helbich; Gertraud Heinz; Shahrokh F Shariat; Hans C Klingler; Michael Rauchenwald; Pascal A Baltzer Journal: Eur Radiol Date: 2016-10-19 Impact factor: 5.315