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Current status of imaging indeterminate renal masses
D S Hartman1, S Aronson, H Frazer
1Department of Radiology/Nuclear Medicine, Uniformed Services University of the Health Sciences, F. Edward Hebert School of Medicine, Bethesda, Maryland.
Radiologic Clinics of North America
|May 1, 1991
Summary
The Bosniak classification system aids in managing renal cysts, distinguishing benign lesions requiring no further evaluation from those needing surgical intervention. This system helps increase conservative treatment for kidney cysts.
Area of Science:
- Radiology
- Urology
- Oncology
Background:
- The Bosniak classification, proposed in 1986, categorizes cystic renal masses based on radiologic findings.
- It aims to differentiate lesions requiring conservative management from those needing surgical exploration.
- The classification has significantly increased the number of patients treated conservatively for renal cysts.
Purpose of the Study:
- To review the Bosniak classification system for renal cysts and cystic renal masses.
- To delineate criteria for benign cysts not requiring further evaluation.
- To identify features indicative of malignancy or the need for surgical intervention.
Main Methods:
- Review of radiologic findings associated with Bosniak categories 1, 2, and 3.
- Description of criteria for benign cysts (Category 1 and 2): simple cysts, cysts with benign calcifications, hyperdense cysts, and cysts with thin septations.
- Identification of features warranting further evaluation or surgery (Category 3): aggressive calcifications, abnormal density, nodular septations, wall thickening, and indeterminate masses.
Main Results:
- Bosniak category 1 and 2 cysts are considered benign and require no further evaluation.
- Features such as aggressive calcifications, abnormal density, nodular septations, and wall thickening indicate Bosniak category 3, warranting further evaluation or surgery.
- Multiloculated masses are typically Bosniak category 3 and require surgery, while most multiple localized renal cysts do not.
Conclusions:
- The Bosniak classification is crucial for guiding the management of cystic renal masses.
- Accurate application of the classification allows for conservative management of benign cysts and timely surgical intervention for potentially malignant lesions.
- Further evaluation methods like angiography or cyst puncture may be necessary for indeterminate masses, with management options ranging from follow-up to nephrectomy.