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Bosniak Cysts

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by

Beth Krautscheid

on 16 January 2013

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Transcript of Bosniak Cysts

Classification, Risk and Treatment Bosniak Renal Cysts Categories Category I Risk of Cancer Category
I
II
IIF
III
IV Management Categories I and II Category II Category IV Category IIF Category III Simple, benign
Wall: hairline thin. No septa, calcifications or solid components
CT: about water-density, no enhancement with contrast Few hairline-thin septa
Wall: possible fine calcifications
CT: Uniform hyperdense lesions <3 cm, no enhancement More hairline thin septa. Possible thick, nodular calcifications (without contrast enhancement)
Wall: minimal thickening
CT: Intrarenal non-enhancing renal lesions >3 cm, well-defined margins Indeterminate cystic masses with thickened, irregular septa
Walls: thickened, irregular
CT: measurable enhancement Indeterminate cystic masses with septa
Walls: thickened, irregular
CT: measurable enhancement. Enhancing soft-tissue components next to wall or septa (tend to be malignant) Designed to help predict probability of kidney cancer Based on: Contrast enhancement, thickness of kidney wall, presence of septa, calcifications, size of mass Risk
0-<2%
13.7%
14.3-24%
50.8%
90.1% Reference: http://www.kidneycancerinstitute.com/kidney-cyst.html Reference: http://radiology.rsna.org/content/249/1/16/F2.expansion.html Reference: http://radiology.rsna.org/content/249/1/16/F2.expansion.html Reference: http://www.sciencedirect.com/science/article/pii/S000992600800442X Categories IIF and III Category IV >10-15 Hounsfield units Further eval not required
Repeat US at 6-12 months
to ensure stability "The optimal approach...is uncertain."
-UpToDate "F is for Follow-up" Step 1: Obtain prior imaging, if available
Step 2: Further imaging with a good-
quality contrast-enhanced MRI
Step 3: Surgical consult Open surgery or
Laprascopic cyst ablation Less post-op pain, shorter hospital stay, more favorable cosmetic result Beth Krautscheid, OHSU MS1 Time 4 the OR
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