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

Sabina Sevcenco, Claudio Spick, Thomas H Helbich, Gertraud Heinz, Shahrokh F Shariat, Hans C Klingler, Michael Rauchenwald, Pascal A Baltzer

Research output: Journal article (peer-reviewed)Review article

66 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)2239-2247
Number of pages9
JournalEuropean Radiology
Volume27
Issue number6
DOIs
Publication statusPublished - 1 Jun 2017

Keywords

  • Databases, Factual
  • Humans
  • Kidney/pathology
  • Kidney Diseases, Cystic/classification
  • Kidney Neoplasms/classification
  • Observer Variation
  • Publication Bias
  • Qualitative Research
  • Research Design
  • Sensitivity and Specificity
  • Tomography, X-Ray Computed
  • Systematic review
  • Bosniak classification
  • Meta-analysis
  • Kidney cancer
  • Renal cysts

ASJC Scopus subject areas

  • Radiology, Nuclear Medicine and Imaging

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