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- Title
Malignancy rates and diagnostic performance of the Bosniak classification for the diagnosis of cystic renal lesions in computed tomography - a systematic review and meta-analysis.
- Authors
Sevcenco, Sabina; Spick, Claudio; Helbich, Thomas; Heinz, Gertraud; Shariat, Shahrokh; Klingler, Hans; Rauchenwald, Michael; Baltzer, Pascal; Helbich, Thomas H; Shariat, Shahrokh F; Klingler, Hans C; Baltzer, Pascal A
- Abstract
<bold>Objective: </bold>To systematically review the literature on the Bosniak classification system in CT to determine its diagnostic performance to diagnose malignant cystic lesions and the prevalence of malignancy in Bosniak categories.<bold>Methods: </bold>A predefined database search was performed from 1 January 1986 to 18 January 2016. Two independent reviewers extracted data on malignancy rates in Bosniak categories and several covariates using predefined criteria. Study quality was assessed using QUADAS-2. Meta-analysis included data pooling, subgroup analyses, meta-regression and investigation of publication bias.<bold>Results: </bold>A total of 35 studies, which included 2,578 lesions, were investigated. Data on observer experience, inter-observer variation and technical CT standards were insufficiently reported. The pooled rate of malignancy increased from Bosniak I (3.2 %, 95 % CI 0-6.8, I2 = 5 %) to Bosniak II (6 %, 95 % CI 2.7-9.3, I2 = 32 %), IIF (6.7 %, 95 % CI 5-8.4, I2 = 0 %), III (55.1 %, 95 % CI 45.7-64.5, I2 = 89 %) and IV (91 %, 95 % CI 87.7-94.2, I2 = 36). Several study design-related influences on malignancy rates and subsequent diagnostic performance indices were identified.<bold>Conclusion: </bold>The Bosniak classification is an accurate tool with which to stratify the risk of malignancy in renal cystic lesions.<bold>Key Points: </bold>• The Bosniak classification can accurately rule out malignancy. • Specificity remains moderate at 74 % (95 % CI 64-82). • Follow-up examinations should be considered in Bosniak IIF and Bosniak II cysts. • Data on the influence of reader experience and inter-reader variability are insufficient. • Technical CT standards and publication year did not influence diagnostic performance.
- Subjects
CYSTIC kidney disease; KIDNEY tumors; CANCER diagnosis; META-analysis; QUANTITATIVE research; DIAGNOSIS
- Publication
European Radiology, 2017, Vol 27, Issue 6, p2239
- ISSN
0938-7994
- Publication type
journal article
- DOI
10.1007/s00330-016-4631-9