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The Histopathologic Correlation of Bosniak 3 Cyst Subclassification.
Ertugrul Sefik1, Ibrahim Halil Bozkurt1, Zehra Hilal Adibelli2
1Department of Urology, Health Sciences University, Bozyaka Training and Research Hospital, Izmir, Turkey.
Urology
|April 23, 2019
Summary
The new Bosniak 3 cyst subclassification (3s and 3n) helps distinguish malignant from benign renal lesions. Bosniak 3n cysts show higher malignancy rates than Bosniak 3s cysts.
Area of Science:
- Urology
- Radiology
- Oncology
Background:
- Complex renal cysts require accurate characterization for appropriate management.
- The Bosniak classification system aids in differentiating cystic renal lesions.
- Recent literature proposes subclassification of Bosniak category 3 cysts.
Purpose of the Study:
- To evaluate the histopathologic correlation of the proposed Bosniak category 3 cyst subclassification.
- To compare Bosniak 3s (septated without nodularity) and 3n (nodularity present) cysts.
- To assess malignancy rates and histopathologic outcomes between Bosniak 3s and 3n cysts.
Main Methods:
- Retrospective review of 106 patients with complex renal cysts (≥Bosniak 3) undergoing nephrectomy.
- Independent re-evaluation of all scans by two uroradiologists.
- Reclassification of Bosniak 3 cysts into 3s and 3n categories based on cyst wall/septal nodularity.
Main Results:
- Among 52 Bosniak 3 cysts, 37 were classified as 3s and 15 as 3n.
- Malignancy rate was significantly higher in the Bosniak 3n group (86.7%) compared to the 3s group (54.1%).
- Malignant Bosniak 3 lesions were smaller than benign lesions.
Conclusions:
- The subclassification of Bosniak 3 cysts into 3s and 3n aids in differentiating malignant from less suspicious lesions.
- Bosniak 3n cysts represent a higher risk for malignancy.
- This subclassification may improve diagnostic accuracy and treatment planning for complex renal cysts.
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