TY - JOUR
T1 - 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
AU - Sevcenco, Sabina
AU - Spick, Claudio
AU - Helbich, Thomas H
AU - Heinz, Gertraud
AU - Shariat, Shahrokh F
AU - Klingler, Hans C
AU - Rauchenwald, Michael
AU - Baltzer, Pascal A
N1 - Publisher Copyright:
© 2016, The Author(s).
PY - 2017/6/1
Y1 - 2017/6/1
N2 - OBJECTIVE: 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.METHODS: 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.RESULTS: 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.CONCLUSION: The Bosniak classification is an accurate tool with which to stratify the risk of malignancy in renal cystic lesions.KEY POINTS: • 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.
AB - OBJECTIVE: 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.METHODS: 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.RESULTS: 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.CONCLUSION: The Bosniak classification is an accurate tool with which to stratify the risk of malignancy in renal cystic lesions.KEY POINTS: • 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.
KW - Databases, Factual
KW - Humans
KW - Kidney/pathology
KW - Kidney Diseases, Cystic/classification
KW - Kidney Neoplasms/classification
KW - Observer Variation
KW - Publication Bias
KW - Qualitative Research
KW - Research Design
KW - Sensitivity and Specificity
KW - Tomography, X-Ray Computed
KW - Systematic review
KW - Bosniak classification
KW - Meta-analysis
KW - Kidney cancer
KW - Renal cysts
UR - http://www.scopus.com/inward/record.url?scp=84991768985&partnerID=8YFLogxK
U2 - 10.1007/s00330-016-4631-9
DO - 10.1007/s00330-016-4631-9
M3 - Review article
C2 - 27761710
SN - 0938-7994
VL - 27
SP - 2239
EP - 2247
JO - European Radiology
JF - European Radiology
IS - 6
ER -