A practical guide and decision-making protocol for the management of complex renal cystic masses
OBJECTIVES: To analyse the management, pathology and outcomes of complex renal cystic masses (CRCM) and to develop a decision-making tool for daily clinical care using the Bosniak classification system for CRCM. PATIENTS AND METHODS: A comprehensive dataset of 185 patients with 188 CRCM and a minimu...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5653609/ https://www.ncbi.nlm.nih.gov/pubmed/29071140 http://dx.doi.org/10.1016/j.aju.2017.02.001 |
Sumario: | OBJECTIVES: To analyse the management, pathology and outcomes of complex renal cystic masses (CRCM) and to develop a decision-making tool for daily clinical care using the Bosniak classification system for CRCM. PATIENTS AND METHODS: A comprehensive dataset of 185 patients with 188 CRCM and a minimum follow-up of 3 years were analysed for management, pathology and outcomes. RESULTS: We analysed 35 Bosniak II, 34 Bosniak IIF, 58 Bosniak III, and 61 Bosniak IV lesions. The overall incidence of renal cell carcinoma was 8.6%, 29.4%, 62.1%, and 78.7% for each category. Based on our surveillance strategy of Bosniak IIF masses, we recommend computed tomography (CT)/magnetic resonance imaging (MRI) every 2 years after the initial examination. We also recommend performing one MRI (as an adjunct to CT) during the early follow-up period (<4 years). The use of MRI correlation for differential diagnostic purposes has proven useful for marginal Bosniak II, IIF and III cases. CONCLUSIONS: From our data, we have created a decision-making protocol to guide urologists in planning a safe and effective diagnostic and treatment strategy for CRCM. The Bosniak classification is a useful tool for clinical decision-making. Uncertainties still remain for Bosniak IIF and III lesions. Our protocol shows that individualised decision-making is necessary in a significant proportion of CRCM. |
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