Utilization of the modified Bosniak classification system for complex renal cysts

Area of Science:

• Pediatric Radiology
• Urologic Oncology
• Diagnostic Imaging

Background:

• Management of solid renal masses typically involves surgery, while simple renal cysts are managed conservatively.
• Optimal management for complex renal cysts in children remains unclear, necessitating improved diagnostic tools.

Purpose of the Study:

• To evaluate the diagnostic performance of the modified Bosniak (mBosniak) classification system for pediatric complex renal cysts through a meta-analysis.

Main Methods:

• A systematic literature search was conducted for studies (1986-2023) using keywords related to the Bosniak classification and pediatric renal cysts.
• Data from 7 retrospective studies involving 154 lesions were extracted and analyzed, focusing on mBosniak categories and histopathological diagnoses.
• Study quality was assessed using the QUADAS-2 tool, with pooled analyses and subgroup investigations performed.

Main Results:

• The meta-analysis included 7 studies with 154 lesions; 70% were intermediate/malignant.
• The mBosniak classification showed pooled sensitivity of 0.88 and specificity of 0.74 for distinguishing benign from intermediate/malignant lesions.
• Intermediate-risk lesions (mBosniak II-III) had lower predictive values, with 24% of intermediate-risk lesions misclassified as lower risk (mBosniak I-II).

Conclusions:

• The mBosniak classification demonstrates limited precision in stratifying intermediate-risk pediatric complex renal cysts.
• The relatively low predictive values for categories II and III question the classification's utility for these lesions.
• Integrating clinical and epidemiological data is recommended for more accurate assessment of pediatric complex renal cysts.