Cystic renal lesions: one centre study


Authors: Tomáš Pitra 1;  Kristýna Pivovarčíková 2;  Radek Tupý 3;  Jiří Kolář 1;  Ondřej Hes 2;  Milan Hora 1
Authors‘ workplace: Urologická klinika LF UK a FN, Plzeň 1;  Šiklův ústav patologie LF UK a FN, Plzeň 2;  Klinika zobrazovacích metod LF UK a FN Plzeň 3
Published in: Ces Urol 2019; 23(2): 131-139
Category:

Overview

Aim: To find the frequency of occurrence of cystic tumours of the kidney, to compare the results of imaging studies with the final histology findings, to retrospectively evaluate possibilities of diagnostics and surgery.

Material a methods: All patients who underwent surgery for the kidney tumour/cystic lesion of the kidney in the time period I/2009-XII/2017 were searched and reevaluated. The patients with cystic renal lesions were included in this study. These patients were reevaluated and classified according to Bosniak (primarily based on CT; ambiguous than an MRI was perfomed. The histological results surgicak options were compared.

Results: In total 1826 patients were included, 247 (14 %) of them with a cystic lesion. Cystic lesions represented 9.8 % of the total amount of neoplasias. Bosniak categories were present as follows Bosniak I in 74 cases (30 %), Bosniak II 13 (5.3 %), Bosniak IIF 28 (11.3 %), Bosniak III 61 (24.7 %) a Bosniak IV 71 (28.7 %). Both CT both MRI were performed in 82 patients (MRI results were the superior).This changed Bosniak classification in 43 patients (52.4 %). Upgrade in Bosniak category in 35 cases (42.7 %) and downgrade in 8 cases (9.7 %). The most frequent type of surgery was nephron-sparing surgery (84.6 %) - 49.4 % resection, 35.2 % ablation. Mini-invasive approach (laparoscopy) in 72.4 %, open surgery in 27.6 %.

Conclusion: Most of the cystic lesions of the kidney can be treated with nephron-sparing surgery. The use of MRI in diagnostics lead to changes in Bosniak classification with direct impact on the next therapeutic management. As a result in our centre we have included MRI in the standard diagnostic algorithm of the cystic lesions in Bosniak IIF and Bosniak III categories.

Keywords:

Bosniak – cyst – kidneys – magnetic resonance – tumour.


Sources

1. Moch H, Cubilla AL, Humphrey PA, Reuter VE, Ulbright TM. The 2016 WHO Classification of Tumours of the Urinary System and Male Genital Organs‑Part A: Renal, Penile, and Testicular Tumours. Eur Urol. 2016; 70(1): 93–105

2. Dušek L, Mužík J, Kubásek M, et al. Epidemiologie zhoubných nádorů v České republice [online]. Masarykova univerzita [2005] [cit. 2019-6-04].

3. Amin MB, Tamboli P, Javidan J, et al. Prognostic impact of histologic subtyping of adult renal epithelial neoplasms: an experience of 405 cases. Am J Surg Pathol. 2002; 26(3): 281–291.

4. Corica FA, Iczkowski KA, Cheng L, et al. Cystic renal cell carcinoma is cured by resection: a study of 24 cases with long‑term followup. J Urol. 1999; 161(2): 408–411.

5. Huber J, Winkler A, Jakobi H, et al. Preoperative decision making for renal cell carcinoma: cystic morphology in cross‑sectional imaging might predict lower malignant potential. Urol Oncol. 2014; 32(1): 37.e1–6.

6. Park HS, Lee K, Moon KC. Determination of the cutoff value of the proportion of cystic change for prognostic stratification of clear cell renal cell carcinoma. J Urol. 2011; 186(2): 423–429.

7. Silverman SG, Israel GM, Herts BR, Richie JP. Management of the incidental renal mass. Radiology 2008; 249(1): 16–31.

8. McGuire BB, Fitzpatrick JM. The diagnosis and management of complex renal cysts. Curr Opin Urol. 2010; 20(5): 349–354.

9. Pitra T, Procházková K, Trávníček I, et al. Cystické tumory ledvin. Klinická urológia 2016: 79.

10. Bosniak MA. The current radiological approach to renal cysts. Radiology 1986; 158(1): 1–10.

11. Berland LL, Silverman SG, Gore RM, et al. Managing incidental findings on abdominal CT: white paper of the ACR incidental findings committee. J Am Coll Radiol. 2010; 7(10): 754–773.

12. Carrim ZI, Murchison JT. The prevalence of simple renal and hepatic cysts detected by spiral computed tomography. Clin Radiol. 2003; 58(8): 626–629.

13. O‚Connor SD, Silverman SG, Ip IK, Maehara CK, Khorasani R. Simple cyst‑appearing renal masses at unenhanced CT: can they be presumed to be benign? Radiology 2013; 269(3): 793–800.

14. Israel GM, Bosniak MA. An update of the Bosniak renal cyst classification system. Urology 2005; 66(3): 484–488.

15. Israel GM, Hindman N, Bosniak MA. Evaluation of cystic renal masses: comparison of CT and MR imaging by using the Bosniak classification system. Radiology 2004; 231(2): 365–371.

16. Bosniak MA. The use of the Bosniak classification system for renal cysts and cystic tumors. J Urol. 1997; 157(5): 1852–1853. 17. Weller A, Barber JL, Olsen OE. Gadolinium and nephrogenic systemic fibrosis: an update. Pediatr Nephrol. 2014; 29(10): 1927–1937.

18. Oyama N, Ito H, Takahara N, et al. Diagnosis of complex renal cystic masses and solid renal lesions using PET imaging: comparison of 11C‑acetate and 18 F‑FDG PET imaging. Clin Nucl Med. 2014; 39(3): e208–214.

19. Schoots IG, Zaccai K, Hunink MG, Verhagen PCMS. Bosniak Classification for Complex Renal Cysts Reevaluated: A Systematic Review. J Urol. 2017; 198(1): 12–21.

20. Ljungberg B, Albiges L, Abu‑Ghanem Y, et al. European Association of Urology Guidelines on Renal Cell Carcinoma: The 2019 Update. Eur Urol. 2019; 75(5): 799–810.

21. Weibl P, Hora M, Kollarik B, Shariat SF, Klatte T. Management, pathology and outcomes of Bosniak category IIF and III cystic renal lesions. World J Urol. 2015; 33(3): 295–300.

22. Pitra T, Pivovarcikova K, Tupy R, et al. Magnetic resonance imaging as an adjunct diagnostic tool in computed tomography defined Bosniak IIF‑III renal cysts: a multicenter study. World J Urol. 2018; 36(6): 905–911.

Labels
Paediatric urologist Nephrology Urology
Login
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account