A practical guide and decision-making protocol for the management of complex renal cystic masses

Peter Weibl; Milan Hora; Boris Kollarik; Kristina Kalusova; Tomas Pitra; Mesut Remzi; Wilhelm Hübner; Pascal Balzer; Tobias Klatte

doi:10.1016/j.aju.2017.02.001

A practical guide and decision-making protocol for the management of complex renal cystic masses

Arab J Urol. 2017 Mar 30;15(2):115-122. doi: 10.1016/j.aju.2017.02.001. eCollection 2017 Jun.

Authors

Peter Weibl¹, Milan Hora², Boris Kollarik³, Kristina Kalusova², Tomas Pitra², Mesut Remzi¹, Wilhelm Hübner¹, Pascal Balzer⁴, Tobias Klatte⁵

Affiliations

¹ Department of Urology, Landesklinikum Korneuburg, Teaching Hospital, Wiener Ring, Austria.
² Department of Urology, Charles University Hospital, Plzen, Czech Republic.
³ Department of Urology, University Hospital - Petrzalka, Bratislava, Slovakia.
⁴ Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria.
⁵ Department of Urology, Medical University of Vienna, Vienna, Austria.

Abstract

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.

Keywords: (CE)US, (contrast-enhanced) ultrasonography; BCS, Bosniak classification system; Bosniak classification; CRCM, complex renal cystic masses; Complex renal; EAU, European Association of Urology; Kidney cancer; Renal cyst; Surveillance.