肾脏囊性病变2019版Bosniak分级的应用及一致性分析

Application and Consistency Analysis of the 2019 Edition of Bosniak Classification of Renal Cystic Lesions

目的评估2005版与2019版Bosniak分级的诊断性能及观察者间的一致性,明确2019版的临床适用性。资料与方法回顾性收集重庆医科大学附属第一医院2013年7月9日—2020年10月9日经手术切除并有术后病理结果的肾囊性病变患者362例共369个病灶。2名放射科医师分别使用2005版和2019版Bosniak分级对病灶的多期CT增强图像进行单盲(病理)评级,使用加权Kappa分析评估观察者间的一致性。计算分级结果的特异度、敏感度评估诊断效能。结果2个版本Bosniak分级的观察者间一致性均较强,且2019版高于2005版(Kappa=0.913、0.843)。对总样本而言,2个版本均具有较高的诊断性能,2019版和2005版分级的特异度分别为97.4%、98.8%,敏感度分别为82.8%、86.2%;去除322例囊肿样本(Ⅰ、Ⅱ级肾囊肿)后,2个版本的诊断特异度均降低,2019版和2005版分别为72.2%、56.6%,差异无统计学意义(χ^(2)=1.333,P=0.25)。结论2019版Bosniak分级通过细化标准,在2005版的基础上提高了观察者间的一致性。2019版分级诊断的特异度有升高趋势,但无显著差异。

Purpose To evaluate the diagnostic performance and the interobserver agreement of Bosniak classification version 2005 and version 2019,and to determine the clinical value of version 2019.Materials and Methods A retrospective study included 362 patients with 369 renal cystic masses who underwent surgical-pathologic examination from July 9,2013 to October 9,2020.Based on version 2005 and version 2019,two radiologists classified all renal cystic masses on multi-phase CT images by single-blind study(pathology results).Interobserver agreement was analyzed via weighted Kappa coefficients.Specificity and sensitivity were performed to calculate diagnostic performance.Results Consistency analysis showed almost perfect performances in both version 2005 and version 2019,and consistency of interobserver agreement of version 2019 was significantly higher than that of version 2005(Kappa=0.913,0.843).For all lesions,the two versions had good similar diagnostic performance,and the specificity of version 2019 and 2005 was 97.4%and 98.8%,respectively;the sensitivity was 82.8%and 86.2%,respectively.After excluding 322 cases with the cyst lesions(classesⅠandⅡrenal cysts),the specificity of version 2019 tended to be higher than that of version 2005,but there was no statistical difference in specificity between version 2019 and 2015(72.2%vs.56.6%,respectively;χ^(2)=1.333,P=0.25).Conclusion Compared with version 2005,version 2019 can improve interobserver agreement through precise classification criteria,with increased specificity of diagnostic performance and without statistical difference.