Ultrasound-based "CEUS-Bosniak"classification for cystic renal lesions: an 8-year clinical experience

Purpose Renal cysts comprise benign and malignant entities. Risk assessment profts from CT/MRI imaging using the Bosniak classifcation. 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 defcit but warrants standardization. This study addresses the benefts 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-classifcation were correlated with histopathological diagnosis. Interobserver agreement between the classifcations 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 classifed 67 lesions as CEUS-Bosniak-IIF, 44 as CEUS-BosniakIII, 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 diferences between CEUS-Bosniak-types concerning cysts size. 99% of lesions showed the same CEUS-Bosniak-type. Conclusion The CEUS-Bosniak classifcation is an essential tool in clinical practice to diferentiate and monitor renal cystic lesions and empowers diagnostic work-up and patient care

Мультилокулярная кистозная почечная неоплазия низкого злокачественного потенциала: опыт НИИ урологии и интервенционной радиологии им. Н.А. Лопаткина

Introduction. Multilocular cystic renal cell neoplasm of low malignant potential (MCRCNLMP) or multilocular cystic renal cell carcinoma (MCRCC) is classified as a distinct nosological unit. Currently, in literature there are no results of studies based on a large number of observations.Objectives: to systemize clinical and pathomorphological characteristics of MCRCNLMP.Materials and methods. In the period from January 2011 to December 2015 in the clinic of the N.N. Lopatkin Scientific Research Institute of Urology and Interventional Radiology, 32 cases of MCRCNLMP were diagnosed among 588 patients. We have studied clinical and morphological characteristics of this disease, surgical approaches to its treatment, and long-term results, which we present in this article.Results. MCRCNLMP comprised 5.44 % of all histological cases of RCC. The majority (75 %) of patients didn’t have clinical manifestations of the disease. Т1а tumor stage corresponded to 65.6 % of tumors, Т1b stage to 28.1 %, and Т2 stage only to 6.2 %. In all cases neoplasm was characterized by moderate and mild differentiation (G1–2) per the grading system of the International Society of Urological Pathology (ISUP). Only 25 % of patients had normal body mass index. In 31 of 32 patients, long-term outcomes were observed. Median follow-up duration was 29 (14–66) months. Progression of the disease wasn’t observed in any of the patients.Conclusion. Patients with MCRCNLMP have the best oncological prognosis among patients with RCC. The necessity of classification of this tumor in accordance with the TNM system is currently dubious. Only organ-preserving surgeries should be used in treatment of the disease. For cases of MCRCNLMP, it is recommended to increase periods of control examinations proposed for patients with RCC, and diagnostic manipulations should be minimal.Введение. Мультилокулярная кистозная почечная неоплазия низкого злокачественного потенциала (МКПННЗП), или мультилокулярный кистозный почечно-клеточный рак (ПКР), в настоящее время выделена в отдельную нозологическую единицу. В литературе не опубликованы результаты крупных исследований, основанных на большом количестве наблюдений.Цель исследования – систематизация клинических и патоморфологических характеристик МКПННЗП.Материалы и методы. В период с января 2011 г. по декабрь 2015 г. в клинике НИИ урологии и интервенционной радиологии им. Н. А. Лопаткина среди 588 больных ПКР диагностированы 32 случая МКПННЗП. Нами были изучены и продемонстрированы клинико-морфологические характеристики данного заболевания, хирургические подходы к его лечению и отдаленные результаты.Результаты. МКПННЗП составила 5,44 % случаев среди всех гистологических форм ПКР. Большинство (75 %) больных не имели клинических проявлений заболевания. Стадия опухолевого процесса Т1а соответствовала 65,6 % опухолей, стадия Т1b – 28,1 % и стадия Т2 – только 6,2 %. Во всех случаях неоплазия характеризовалась средней и умеренной дифференцировкой (G1–2) ядерной градации Интернационального общества урологических патологов (International Society of Urological Pathology, ISUP). Отмечено, что только 25 % больных имели нормальный показатель индекса массы тела. У 31 из 32 пациентов прослежены отдаленные результаты. Медиана наблюдения составила 29 (14–66) мес. Ни у одного пациента не выявлено признаков прогрессирования заболевания.Заключение. Больные МКПННЗП обладают наилучшим онкологическим прогнозом среди пациентов с ПКР. Необходимость классификации этой опухоли по системе TNM в настоящее время является сомнительной. В качестве хирургического лечения следует использовать только органосохраняющие операции. В случае МКПННЗП рекомендуется увеличить периоды между контрольными обследованиями, предложенные для больных ПКР, а комплекс диагностических манипуляций должен быть сведен до минимума

Rare Tumours of the Kidney - Cystic Tumours of the Kidney

Aim: To quantify the occurrence of cystic tumours of the kidney in a population of patients with tumour of the kidney. Other goals of this study were to compare results of imaging studies with the results of final histology, to evaluate malignity rate in each Bosniak group and to evaluate the options of surgical treatment of cystic tumours of the kidney. The emphasis was placed to determine the benefits of magnetic resonance imaging in the diagnostic algorithm of cystic tumours of the kidney. Material and methods: All patients, who underwent surgery for the tumour of the kidney or cystic lesion of the kidney at our department in the time period 2009-17 were evaluated and patients with radiologically described cystic lesion of the kidney were included in the cohort. Lesions were classified according to CT imaging in the Bosniak categories. The unclear findings were in clinical study consulted with the radiologist. In case of uncertainties, MRI was indicated. Histological classification of all neoplasias was done according to the WHO classification 2016. The cohort of cystic lesions (n=247) was stratified into two groups. Categories Bosniak I-IIF (n=115), which were treated surgically not for suspicion of the malignity, but because of the size, localisation, clinical manifestation or were solved...Cíl: Kvantifikovat výskyt cystických nádorů ledvin v celkové populaci pacientů s nádory ledvin, komparovat výsledky zobrazovacích vyšetření s definitivní histologií, zhodnotit frekvenci výskytu maligních lézí v jednotlivých kategoriích dle Bosniaka a zhodnotit možnosti operační léčby cystických renálních tumorů. Determinovat přínos využití magnetické rezonance v diagnostickém algoritmu cystických lézí ledvin. Materiál a metody: Byli vyhledáni a opětovně hodnoceni všichni pacienti léčení chirurgicky na Urologické klinice FN Plzeň pro renální tumor či cystickou lézi ledvin v letech 2009-17. Z celkového souboru byli vyčleněni pacienti s cystickou renální lézí (úvodně detekovanou radiologicky), u nichž byly následně standardizovaně přezkoumány výsledky zobrazovacích vyšetření a histologický nález. Ve standardním diagnosticko-léčebném algoritmu jsou léze radiologicky klasifikovány dle Bosniaka (na základě CT). U nejasných nálezů bylo v rámci klinické studie doplněno vyšetření MR. Všechny neoplásie byly při zpracování výsledků histologicky reklasifikovány dle recentní WHO klasifikace nádorů ledvin z roku 2016. Vlastní soubor cystických lézí (n=247) byl následně stratifikován do dvou podsouborů. Kategorie Bosniak I-IIF (n=115), které byly operačně řešeny nikoliv z důvodu podezření na přítomnost malignity,...Klinika urologickáLékařská fakulta v PlzniFaculty of Medicine in Pilse