Clinical Study And Application Of Bosniak Grading System In Complicated Renal Cystic Lesions

Objective:To analyze the clinical and pathological characteristics of patients with complicated renal cystic lesions,and to explore the value of Bosniak grading system in judging benign and malignant renal cystic lesions and clinical application,and to analyze and find appropriate clinical intervention methods,so as to provide reference and guidance for future clinical work.Methods:A retrospective analysis was made of 390 cases of complicated renal cystic lesions,diagnosed by urology department of the First Hospital of Shanxi Medical University from January 2017 to December 2018.The clinical data such as sex,age,cystic lesion characteristics(number,size,shape,segregation,nature of cystic contents,etc.),surgical methods and postoperative pathological reports were collected for statistical analysis.?nferred the ability of the Bosniak grading system to diagnose the benign and malignant renal cystic lesions.The SPSS 22.0 statistical software was used to analyze and draw the receiver operating characteristic curve(ROC curve),and to determine the best dividing point of Bosniak classification system for benign and malignant differentiation of complex renal cystic lesions.Bosniak ? was further subgraded to determine the diagnostic significance of Bosniak ? subgrading for benign and malignant complex renal cystic lesions.Results:Bosniak classification was performed in 390 patients with renal cystic lesions by CT?MR? or CEUS.With Bosniak ? grade 62.8%(245/390),grade ? 12.1%(47/390),and ?F grade 5.6%(22/390),Grade 7.2%(28/390),Grade ?V 12.3%(48/390).Renal cystic benign lesions accounted for 83.1%(324/390)and malignant lesions accounted for 16.9%(66/390).And the rates of malignant renal cystic lesions in each group were: grade ? 0.8%(2/245),grade ? 4.3 %(2/47),?F grade 9.1%(2/22),grade ? 60.7%(17/28),grade ?V 89.6%(43/48),the difference between the groups was statistically significant(p<0.05).Combined with ROC curve and area under curve(AUC = 0.960;95% C?: 0.930-0.989),Bosniak ? is the best boundary point for judging benign and malignant renal cystic lesions.The data of this study showed that the sensitivity of this boundary to predict malignant transformation of renal cystic lesions was 90.9%,the specificity was 95.1%,the positive predictive value was 96.63%,and the negative predictive value was 87.12%.There were significant differences between Bosniak ? n(nodularity)and Bosniak ? s(septated)groups.Conclusion:The Bosniak grading system has a good predictive effect on benign and malignant renal cystic lesions.Clinicians can choose one or more imaging examinations according to the characteristics of patients to improve the diagnostic rate of renal cystic lesions.?ntervention on renal cystic lesion,Bosniak ? and ? usually do not need to follow-up,the Bosniak ? F should follow the routine imaging,and according to the imaging changes further intervention or termination of the follow-up.Active surgical treatment is still recommended for Bosniak ? or ?V.Especially the lesions above the Bosniak ? n.Appropriate surgical procedures should be selected according to the patient's individual condition.Laparoscopic partial nephrectomy with nephron sparing is generally the first choice.