Contrast-enhanced ultrasound-based Bosniak classification for evaluating of a cystic renal mass: a rare case description of renal hemolymphangioma.
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ABSTRACT:
SUBMITTER: Wang H
PROVIDER: S-EPMC9929411 | biostudies-literature | 2023 Feb
REPOSITORIES: biostudies-literature
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Contrast-enhanced ultrasound-based Bosniak classification for evaluating of a cystic renal mass: a rare case description of renal hemolymphangioma.
Wang Hong H Cao Jiazhi J Huang He H Yang Dan D Wu Zhenru Z Luo Yan Y Ling Wenwu W
Quantitative imaging in medicine and surgery 20221207 2
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Project description:Bosniak 2F renal cystic lesions feature morphologic characteristics between Bosniak I and III categories, the majority of which remain benign. However, a minor part of Bosniak 2F lesions may progress to malignancy. The purpose of this study was to assess Bosniak 2F cystic lesions during follow-up examinations by CEUS. One-hundred-and-twelve out of 364 patients with Bosniak 2F lesions underwent follow-up CEUS examinations between February 2008 and February 2020. Twelve out of 364 patients underwent renal surgery without follow-up CEUS. The progression rate of Bosniak 2F renal lesions detected by CEUS accounted for 7.1% (8/112 patients) after a mean of 12.9 months. The first follow-up CEUS revealed 75% of progressions (6/8), the remaining 25% (2/8) of progressions were detected during second follow-up CEUS. Underlying clear-cell renal cell carcinoma was histopathologically validated in 5/8 progressive complex cystic renal lesions. Stable sonomorphologic features were observed in 92.1% (104/112 patients). CEUS depicts a promising diagnostic imaging modality in the diagnostic work-up and follow-up of complex renal cystic lesions at higher spatial and temporal resolutions than CT or MRI. Its excellent safety profile, its easy and repeatable accessibility, and low financial costs render CEUS an attractive and powerful alternative imaging tool for monitoring complex renal cystic lesions.
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Project description:Background and objectives: The aim of the present retrospective single-center study is to evaluate the diagnostic performance of contrast-enhanced ultrasound (CEUS) for assessing Bosniak III complex renal cystic lesions with histopathological validation. Materials and Methods: 49 patients with CEUS-categorized Bosniak III renal cystic lesions were included in this retrospective study. All patients underwent native B-mode, Color Doppler, contrast-enhanced ultrasound (CEUS) between 2010-2020. Eight and five patients underwent computed tomography (CT) and magnetic resonance imaging (MRI), respectively. Twenty-nine underwent (partial) nephrectomy allowing for histopathological analysis. The applied contrast agent for CEUS was a second-generation blood pool agent. Ultrasonography examinations were performed and interpreted by a single experienced radiologist with more than 15 years of experience (EFSUMB Level 3). Results: CEUS examinations were successfully performed in all included patients without registering any adverse effects. The malignancy rate of CEUS-categorized Bosniak III renal lesions accounted for 66%. Initially, cystic complexity was visualized in native B-mode. In none of the renal lesions hypervascularization was detected in Color Doppler. CEUS allowed for detection of contrast enhancement patterns in all included Bosniak III renal lesions. Delayed wash-out could be detected in 6/29 renal lesions. In two cases of histopathologically confirmed clear-cell RCC, appropriate up-grading from Bosniak IIF to III was achieved by CEUS. Conclusions: CEUS depicts a promising imaging modality for the precise diagnostic workup and stratification of renal cystic lesions according to the Bosniak classification system, thereby helping guidance of adequate clinical management in the future.
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Project description:ObjectiveTo 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.MethodsA 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.ResultsA 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.ConclusionThe 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.
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Project description:Multicystic renal lesions pose a diagnostic dilemma and standard imaging may not be able to differentiate between benign or malignant lesions. Adult cystic nephroma and multicystic renal cell carcinoma are two such cystic renal lesions. We describe the appearance of cystic nephroma using contrast enhanced ultrasound. We hypothesize how quantitative parameters using time intensity curves appear to be able to distinguish between cystic nephroma and other malignant lesions such as multicystic renal cell carcinoma. This differentiation is of importance as it may obviate the need for tissue sampling and allow the clinician to recommend conservative management rather than nephrectomy.
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Project description:Testicular tuberculosis is a rare form of genital tuberculosis. Ultrasound is a crucial tool for evaluating male genital disorders. Contrast-enhanced ultrasonography (CEUS), which provides real-time monitoring of microvascular hemodynamics, provides rich information about microcirculation, helping distinguish testicular tuberculosis from other testicular conditions such as tumors and inflammation. This study reports on a rare case of testicular tuberculosis diagnosed through CEUS. A 31-year-old male patient presented with two months of persistent right scrotal pain and swelling. Conventional scrotal ultrasound showed an enlarged right testicle with heterogeneous echogenicity and abundant color Doppler blood flow signals. CEUS demonstrated rapid contrast agent filling in the right testicle, followed by the appearance of several irregular regions, indicating perfusion deficits in these areas. Histopathological confirmation through ultrasound-guided biopsy revealed granulomatous inflammation with caseous necrosis, which is consistent with the diagnosis of testicular tuberculosis. As a real-time monitoring technique for microvascular hemodynamics, CEUS provides valuable microcirculatory information that enhances diagnostic accuracy and enables the formulation of appropriate treatment plans for testicular tuberculosis versus other testicular pathologies.
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Project description:BackgroundRenal cell carcinoma (RCC), the most common malignant renal tumor, is primarily treated by surgical resection, including radical nephrectomy (RN) and partial nephrectomy (PN). At present, the choice of surgery mainly depends on the comprehensive evaluation of patients' clinical data, including histological classification, such as clear cell renal cell carcinoma (ccRCC) and non-clear cell renal cell carcinoma (nccRCC), and RENAL (radius, exophytic/endophytic, nearness, anterior/posterior, and location) score. Compared with biopsy and contrast-enhanced computed tomography (CECT), contrast-enhanced ultrasound (CEUS) is safer and less invasive. The purpose of this study was to assess the value of CEUS in the preoperative evaluation of histological classification and RENAL score of RCC.MethodsThis retrospective study was conducted on a consecutive series of patients with renal tumors who underwent CEUS examination within 1 week prior to treatment at Lanzhou University Second Hospital between March 2021 and November 2023. The conventional ultrasound and CEUS features of RCCs were recorded and used to evaluate the RENAL score. Binary logistic regression was applied to analyze the independent risk factors of ccRCC. Diagnostic efficacy in evaluating ccRCC and nccRCC was compared between CEUS and CECT with the McNemar test.ResultsAmong 246 patients, 248 RCCs were enrolled and were categorized into two groups: ccRCC (n=196) and nccRCC (n=52), with surgical pathology as the reference standard. The likelihood of hyperenhancement (P<0.001), heterogeneous enhancement (P<0.001), internal nonenhanced region ≤50% (P=0.001), and fast wash-in (P<0.001) in the ccRCC group was significantly higher than that in the nccRCC group, and these were independent risk factors of ccRCC. Moreover, the ccRCC group, as compared to the nccRCC, had a lower region of interest area of the largest range of tumor (Areamax) (P=0.045) and the difference between the local tumor and cortex in arrive time (∆ATtumor-cortex) (P=0.012) and shorter time to peak of the local tumor (TTPtumor) (P=0.022). The performance of CEUS in differentiating between ccRCC and nccRCC was comparable to that of CECT and showed high sensitivity (99.5%). Additionally, there was a significant difference in RENAL score based on the ultrasound features between the RN and PN group (P<0.001).ConclusionsThe conventional ultrasound and CEUS features may help differentiate ccRCC from nccRCC and have significant potential in scoring the complexity prior to surgery, which could provide more precise and valuable information for diagnosis and treatment. CEUS has the capacity to optimize the treatment plan in a noninvasive manner and improve the prognosis of patients and should thus be further verified in multicenter, large-cohort, prospective research.
| S-EPMC11651922 | biostudies-literature
Project description:There may be surgical overtreatment of complex cystic renal masses (CRM). Growing evidence supports active surveillance (AS) for the management for Bosniak IIF-III CRMs. We aimed to evaluate and compare oncological and pathological outcomes of Bosniak IIF-IV CRMs treated by initial surgery (IS) or AS. We identified retrospectively 532 patients with CRM counseled during 2006-2017. IS and AS were delivered to, respectively, 1 and 286 patients in Bosniak IIF, to 54 and 85 patients in III and to 85 and 21 patients in Bosniak IV. Median follow-up was 66 months (IQR 50-96). Metastatic progression occurred for 1 (0.3%) AS patient in Bosniak IIF, 1 IS (1.8%) and 1 AS (1.2%) patient in Bosniak III and 5 IS (3.5%) patients in Bosniak IV, respectively. Overall 5-year metastasis-free survival was 98.9% and cancer-specific survival was 99.6% without statistically significant difference between IS and AS in Bosniak IIF-IV categories. AS did not increase the risk of metastatic spread or cancer-specific mortality in patients with Bosniak IIF-IV. Our data indicate AS in Bosniak IIF and III is safe. Surgery is the primary treatment for Bosniak IV due to its high malignancy rate.
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Project description:BackgroundAdvances in imaging have improved the detection rate of pancreatic cystic neoplasms (PCNs), but clinical management varies depending on the pathological type of PCNs, and thus accurate differential diagnosis is of considerable clinical significance. We conducted this study to identify the clinical and sonographic features of PCNs with significance for differential diagnosis and to compare the diagnostic accuracy of conventional ultrasound and conventional ultrasound combined with contrast-enhanced ultrasound (CEUS) for PCNs.MethodsFrom January 1, 2011, to December 31, 2022, a total of 100 patients with PCNs who underwent CEUS examination and were confirmed to have PCNs by postoperative pathology in West China Hospital of Sichuan University were included in this study.ResultsOf the clinical characteristics of PCNs, age and gender were found to be important differential diagnostic features. Moreover, communication of the lesion with the main pancreatic duct on conventional ultrasound and CEUS images was a critical feature in the differential diagnosis of intraductal papillary mucinous neoplasm (IPMN). The size of the lesion, the thickness of the cyst wall and the number of septa in conventional ultrasound images, the uniformity of the cyst wall thickness in CEUS images, and the enhancement pattern in the arterial phase were significant features for the differential diagnosis of serous cystic neoplasm (SCN). Cyst wall thickness and uniformity of the cyst wall thickness in conventional ultrasound images and cyst wall thickness and septa thickness in CEUS images were important features in the differential diagnosis of mucinous cystic neoplasm (MCN). The size and internal components of the lesion on conventional ultrasound images, internal components of the lesion, and the enhancement pattern in the arterial phase and rim enhancement on CEUS images were the key features in the differential diagnosis of solid pseudopapillary neoplasm (SPN). Conventional ultrasound combined with CEUS demonstrated significantly greater accuracy than did conventional ultrasound alone in the differential diagnosis of PCNs (66% vs. 79%; P=0.002).ConclusionsPCN types differ in their clinical and ultrasound features. Conventional ultrasound combined with CEUS can better distinguish between different pathological types of PCNs than can conventional ultrasound alone.
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Project description:ObjectiveThe objective was to assess the interobserver agreement rate, progression rates and malignancy rates in the assessment of complex renal cysts (≥ Bosniak IIF) using a population-based database.MethodsA regional database identified 452 complex renal cysts in 415 patients between 2009 and 2019. Each patient was tracked and followed up using a unique identifier and deterministic linkage methodology. The interobserver agreement rate between radiologists was calculated using a weighted kappa statistic. Progression and malignancy rates of cysts (Bosniak ≥IIF) over the 11-year period were calculated.ResultsThe linear-weighted kappa value was 0.69 for all complex cysts. The rate of progression and regression of Bosniak IIF cysts was 4.6% (7/151) and 3.3% (5/151), respectively. All malignant IIF cysts progressed within 16 months of diagnosis. The malignancy rate of surgically resected Bosniak III and IV cysts was 79.3% (23/29) and 84.5% (39/46), respectively. Of all malignant tumours, 73.8% and 93.7% were of low ISUP grade and low stage, respectively.ConclusionsThis study further confirms that there is a good degree of agreement between radiologists in classifying complex renal masses using the Bosniak classification. The progression rate of Bosniak IIF cysts is low, but the malignancy rates of surgically resected Bosniak IIF, III and IV cysts are high. Benign cysts are frequently resected, and a very high proportion of histopathologically confirmed cancers in complex renal cysts are of low grade and stage.Key points• There is a good degree of agreement between radiologists in classifying complex renal masses using the Bosniak classification. • The rate of progression of Bosniak IIF cysts is low, and malignant cysts progress early during surveillance. Although the malignancy rates of resected Bosniak IIF, III and IV cysts are high, the rate of benign cyst resection is significant.
| S-EPMC7813744 | biostudies-literature