Bosniak分级在肾囊性病变良恶性诊断的应用价值

Clinical reliability of the Bosniak classification as a diagnostic method of renal cysts

目的:分析肾囊性病变的临床及病理学特点,探讨Bosniak分级对肾囊性病变良恶性诊断的临床应用价值。方法:回顾性分析CT或MRI诊断为肾囊性病变的239例患者的临床资料,所有患者都行手术治疗,分析在不同Bosniak分级中肾囊性病变良恶性比例,用ROC曲线确定Bosniak分级在肾囊性病变中鉴别良恶性的最佳分界点。结果:在239名肾囊性病变手术患者中,恶性病变48例(20.1%),良性病变191例(79.9%),不同Bosniak分级及恶性病变率为:Ⅰ级1.7%(2/121)、Ⅱ级4.8%(1/21)、ⅡF级9.3%(4/43)、Ⅲ级50%(11/22)、Ⅳ级93.8%(30/32)。术后病理显示:恶性病变48例(透明细胞癌41例,乳头状细胞癌4例,囊性肾癌3例),单纯肾囊肿187例,肾错构瘤3例,肾囊性肾瘤1例。ROC曲线结果显示,BosniakⅢ级为判断肾囊性病变良恶性的最佳分界点,其预测肾囊性病变恶性的敏感性为86.0%,特异性为94.2%,阳性预测值为79.6%,阴性预测值为96.2%。结论:Bosniak分级对肾囊性病变良恶性的判断具有较高的临床应用价值,Bosniak分级≥Ⅲ级时,肾囊性病变恶性率较高,应积极进行手术治疗。

Objective： To analyze the clinical and pathologic features of cystic renal masses, and to evaluate the clinical reliability of the Bosniak classification. Methods： The clinical data of 239 patients of renal cysts diagnosed by CT or MRI scan were retrospectively reviewed. All patients were treated through operation .The benign/malignant ratio and clinical characteristics of each category were analyzed. ROC curve was applied to determine the cut-off point that identified the benign and malignancy in the renal cysts based on Bosniak classification. Results： In 239 surgically excised lesions from patients with renal cysts, the percentages of malignancy in the different Bosniak classifications were as follows： category I, 1.7% （2 of 121）; II, 4.8% （1 of 21）; IIF, 9.3% （4 of 43）; III, 50.0% （11 of 22）; and IV, 93.8% （30 of 32）. Postoperative pathological examination detected malignant tumors in 48 cases （41 clear cell carcinoma,4 papillary carcinoma and 1 cystic renal cell carcinoma）. A total of 191 cases were benign （185 simple cyst, 3 renal angiomyolipoma and 1 multilocular cystic nephroma）. According to the ROC curve, Bosniak category Ⅲ was the cut-off point to predict malignancy of renal cysts with sensitivity of 86.0%, specificity of 94.2%, 79.6% positive predictive value, and 96.2% negative predictive value. Conclusion： The Bosniak classification system may have high clinical reliability as a diagnostic method of renal cysts, and the Bosniak category Ⅲ and Ⅳ cystic renal lesions are more likely to be malignant. Therefore, surgical operation is advised.