Outcomes and complications related to the management of Bosniak cystic renal lesions.

Published

Journal Article

OBJECTIVE: The objective of our study was to evaluate outcomes and complications related to the management of Bosniak category IIF, III, and IV renal cysts. MATERIALS AND METHODS: For this multiinstitutional retrospective study, a Web-based Research Electronic Data Capture (REDCap) data registry was used to record data of 286 adult patients with 312 prospectively classified Bosniak IIF, III, and IV renal cysts diagnosed between January 2000 and October 2011. Included patients were managed by surgery (n = 86), percutaneous ablation (n = 19), or imaging surveillance of 1 year or more (n = 181). The median number of years of clinical surveillance was 2.4 years (range, 0-11.7 years), 2.6 years (range, 0.4-11.4 years), and 3.2 years (range, 1.1-11.6 years) for patients managed by surgery, ablation, and imaging surveillance, respectively. Pathologic and survival outcomes and complications related to management were evaluated. RESULTS: The malignancy rate at surgical pathology was 38% (3/8) for Bosniak IIF, 40% (29/72) for Bosniak III, and 90% (18/20) for Bosniak IV renal cysts. There were no metastases or deaths (0/144) directly related to Bosniak IIF renal cysts. There were no deaths (0/113) directly related to Bosniak III renal cysts, although one patient (1/113) developed local progression and lung metastases after thermal ablation. One patient with a Bosniak IV renal cyst (1/29) presented with and died of metastatic disease. Moderate to severe complications occurred in 19% (16/86), 5% (1/19), and 0% (0/181) of patients managed by surgery, ablation, and imaging surveillance, respectively (p < 0.0001). Severe complications occurred in 7% (6/86) of surgical patients and included multiorgan failure (n = 2), acute myocardial infarction (n = 1), acute ischemic stroke (n = 1), conversion to hemodialysis-dependent chronic kidney disease (n = 1), and postoperative severe hemorrhage (n = 1). CONCLUSION: There were no deaths from Bosniak IIF or III renal cysts regardless of management approach. Moderate to severe complications are frequent in patients managed by surgery.

Full Text

Duke Authors

Cited Authors

  • Smith, AD; Allen, BC; Sanyal, R; Carson, JD; Zhang, H; Williams, JH; Collins, C; Griswold, M; Zhang, X

Published Date

  • May 2015

Published In

Volume / Issue

  • 204 / 5

Start / End Page

  • W550 - W556

PubMed ID

  • 25905961

Pubmed Central ID

  • 25905961

Electronic International Standard Serial Number (EISSN)

  • 1546-3141

Digital Object Identifier (DOI)

  • 10.2214/AJR.14.13149

Language

  • eng

Conference Location

  • United States