The Modified Bosniak Classification for Intermediate-Risk Renal Cysts in Children

Area of Science:

• Pediatric Radiology
• Renal Cyst Classification
• Diagnostic Imaging Accuracy

Background:

• The modified Bosniak classification system is used to categorize renal cysts based on imaging features.
• Accurate classification is crucial for determining appropriate management, especially for intermediate-risk lesions.
• Previous studies have focused on adult populations, with limited data on pediatric applications.

Purpose of the Study:

• To evaluate the correlation between radiologist-assigned modified Bosniak categories and histological findings in pediatric renal cysts.
• To assess the inter-rater reliability of the modified Bosniak classification among pediatric radiologists.
• To determine the diagnostic accuracy of the system for differentiating benign from intermediate-risk lesions in children.

Main Methods:

• Retrospective analysis of pediatric patients with intermediate-risk complex renal cysts (2006-2019).
• Four pediatric radiologists from two centers independently classified cyst complexity using the modified Bosniak system.
• Histological results were used as the reference standard.
• Diagnostic accuracy and inter-rater reliability (Krippendorff's α) were calculated.

Main Results:

• Seven pediatric patients with intermediate-risk complex renal cysts were included.
• Overall correct classification rate was 73.2% (41/56 readings).
• Inter-rater reliability was poor, with Krippendorff's α = 0.08 for binary Bosniak categories (I-II vs III-IV).

Conclusions:

• The modified Bosniak classification demonstrates significant underestimation of intermediate-risk in pediatric renal cysts.
• Low inter-rater consistency among radiologists hinders its utility in guiding pediatric cyst management.
• Clinicians should exercise caution when applying the modified Bosniak system to children due to reliability concerns.