基于2019版Bosniak分级系统对肾囊性病变的MSCT与病理对照研究

Correlative study between MSCT and histopathology based on bosniak classification version 2019

目的:探讨如何利用2019版Bosniak分级系统,根据MSCT影像诊断结果制定复杂性肾囊性病变的治疗策略。方法:由两位影像科医生根据2019版Bosniak分级系统,独立对MSCT诊断为复杂肾囊性病变的140例患者的图像进行再次评级,并分析其与术后病理良恶性的关联。结果:将不适用于分级的3例病例排除后,137例复杂性肾囊性病变中术后病理为恶性病变者69例(50.3%),良性病变者68例(49.7%)。两位医师根据Bosniak分级系统对于肾恶性病变鉴别的曲线下面积(AUC)分别为0.971(95%CI:0.939~1.003)、0.949(95%CI:0.912~0.987);两位医师诊断的一致性Kappa值为0.597(P<0.001)。对于恶性病变的诊断界值,甲医师为Ⅳ级,诊断敏感度为97.1%,特异度为95.6%;乙医师为ⅡF级,诊断敏感度为97.1%,特异度为82.4%。结论:2019版Bosniak分级系统对恶性肾囊性病变具有良好的诊断效能。由于临床实践中对过渡级别(ⅡF~Ⅲ)病变的报告准确度存在差异,对于影像评级IIF以上的肾囊性肿物,需根据实际情况谨慎考虑处理策略,尽可能避免肿瘤种植和贻误治疗时机。

Objective:To formulate the treatment strategy of complex renal cysts according to MSCT diagnosis reasonably with bosniak classification.Methods:According to the new Bosniak classification,two radiologists independently rated the 140 cases of MSCT diagnosed as complex renal cyst,and analyzed theirs correlation with postoperative pathological benign and malignant.Results:After excluding 3 cases that were not suitable for classification,69 cases(50.3%)of 137 cases were malignant tumors,68 cases(49.7%)were benign tumors.According to the Bosniak classification,the diagnostic AUC values of the two radiologists for malignant renal tumors were 0.971(95%CI:0.939~1.003)and 0.949(95%CI:0.912~0.987),respectively.The kappa value was 0.597,P<0.001.For the diagnostic cut-off point of malignant tumor,radiologist A was categoryⅣ(sensitivity 97.1%,specificity 95.6%)while radiologist B was categoryⅡF(sensitivity 97.1%,specificity 82.4%).Conclusion:The new Bosniak classification has good diagnostic efficacy for the malignant renal cystic lesions.Due to the difference in reporting accuracy of transition categories(ⅡF~Ⅲ),clinicians need to consider the necessity of surgical treatment for cystic renal masses rated above Bosniak categoryⅡF according to the actual situation,to avoid tumor implantation and delaying the treatment opportunity.