Clinical utility of the Bosniak classification version 2019: Diagnostic value of adding magnetic resonance imaging to computed tomography examination

Yuki Arita; Soichiro Yoshida; Thomas C Kwee; Hiromi Edo; Ryohei Kufukihara; Keisuke Shigeta; Misa Nagasaka; Ryo Takeshita; Haruka Okamura; Ryo Ueda; Ryota Ishii; Shigeo Okuda; Yasuhisa Fujii

doi:10.1016/j.ejrad.2022.110163

Clinical utility of the Bosniak classification version 2019: Diagnostic value of adding magnetic resonance imaging to computed tomography examination

Eur J Radiol. 2022 Mar:148:110163. doi: 10.1016/j.ejrad.2022.110163. Epub 2022 Jan 19.

Authors

Yuki Arita¹, Soichiro Yoshida², Thomas C Kwee³, Hiromi Edo⁴, Ryohei Kufukihara⁵, Keisuke Shigeta⁶, Misa Nagasaka⁷, Ryo Takeshita⁸, Haruka Okamura⁹, Ryo Ueda¹⁰, Ryota Ishii¹¹, Shigeo Okuda¹², Yasuhisa Fujii¹³

Affiliations

¹ Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. Electronic address: [email protected].
² Department of Urology, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan. Electronic address: [email protected].
³ Department of Radiology, Nuclear Medicine, and Molecular Imaging, University Medical Center Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB Groningen, the Netherlands. Electronic address: [email protected].
⁴ Department of Radiology, National Defense Medical College, 3-2, Namiki, Tokorozawa, Saitama 359-8513, Japan. Electronic address: [email protected].
⁵ Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. Electronic address: [email protected].
⁶ Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. Electronic address: [email protected].
⁷ Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. Electronic address: [email protected].
⁸ Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. Electronic address: [email protected].
⁹ Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. Electronic address: [email protected].
¹⁰ Office of Radiation Technology, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. Electronic address: [email protected].
¹¹ Department of Biostatistics, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki 305-8575, Japan. Electronic address: [email protected].
¹² Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. Electronic address: [email protected].
¹³ Department of Urology, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan. Electronic address: [email protected].

PMID: 35066340
DOI: 10.1016/j.ejrad.2022.110163

Abstract

Purpose: To assess the impact of the updated Bosniak classification (BC2019) for cystic renal masses (CRMs) on interobserver agreement between radiologists and urologists and the diagnostic value of adding MRI to CT examination (combined CT/MRI).

Method: This study included 103 CRMs from 83 consecutive patients assessed using contrast-enhanced CT and MRI between 2010 and 2016. Nine readers in three groups (three radiologists, three radiology residents, and three urologists) reviewed CT alone and the combined CT/MRI using BC2019. Bosniak category was determined by consensus in each group for diagnosing malignancy, with a cut-off category of ≧III. Interobserver agreement was assessed using Fleiss' kappa values. The effect of CT or combined CT/MRI on the diagnosis of malignancy was assessed using McNemar's test.

Results: Interobserver agreement of BC2019 for CT alone was substantial for radiologists and residents, moderate for urologists (0.77, 0.63, and 0.58, respectively). Interobserver agreement of BC2019 for combined CT/MRI was substantial for all three groups (radiologists: 0.78; residents: 0.65; and urologists: 0.61). Among residents, the sensitivity/specificity/accuracy rates of combined CT/MRI vs. CT alone were 82.1/74.7/76.7% vs. 75.0/66.7/68.9%, and specificity and accuracy were significantly higher for combined CT/MRI than that for CT alone (p = 0.03 and 0.008, respectively). Similarly, sensitivity/specificity/accuracy values were significantly higher for combined CT/MRI among urologists (78.6/73.3/74.8% vs. 64.3/64.0/64.1%, p = 0.04/0.04/0.008). However, sensitivity/specificity/accuracy did not significantly differ between the two among radiologists (89.3/74.7/78.6% vs. 85.7/73.3/76.7%, p = 0.32/0.56/0.32).

Conclusions: Combined CT/MRI is useful for diagnosing malignancy in patients with CRMs using BC2019, especially for non-expert readers.

Keywords: 2019 Bosniak classification; Cystic renal mass; Magnetic resonance imaging; Renal cell carcinoma; Tomography.

MeSH terms

Humans
Kidney Diseases, Cystic* / pathology
Kidney Neoplasms*
Magnetic Resonance Imaging
Retrospective Studies
Tomography, X-Ray Computed