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e-CASES: Bosniak classification - Renal Cysts

Dr Antoine Micheau

Bosniak classification

Bosniak I:

- Benign simple cyst with a hairline-thin wall that does not contain septa, calcifications, or solid components

- water attenuation

- does not enhance

- % malignant : ~ 0

- No intervention is needed

 

Bosniak II:

- Benign cystic lesion that may contain a few hairline-thin septa in which perceived (not measurable) enhancement may be appreciated

- Fine calcification or a short segment of slightly thickened calcification may bepresent in the wall or septa

- Uniformly high-attenuating lesions (< 3 cm) that are sharply marginated and do not enhance are included in this group.

- % malignant : ~ 0

- No intervention is needed

 

Bosniak IIF:

- Cysts may contain multiple hairline-thin septa

Perceived (not measurable) enhancement of a hairline-thin smooth septum or wall can be identified;

- Possible minimal thickening of wall or septa, which may contain calcification that may be thick and nodular, but no measurable contrast enhancement is present

- No enhancing soft-tissue components

- Totally intrarenal nonenhancing high-attenuating renal lesions (>3 cm) also included in this category(lesions generally well marginated)

- % malignant : ~ 5 %

- Thought to be benign but need follow-up to prove their benignity by showing stability

 

 

Bosniak III

- Cystic masses with thickened irregular or smooth walls or septa and in which measurable enhancement is present;

- % malignant : ~ 50%

- Need surgical intervention in most cases with histologic diagnosis, as neoplasm cannot be excluded

- This category includes complicated hemorrhagic or infected cysts, multilocular cystic nephroma, and cystic neoplasms

 

Bosniak IV

- Clearly malignant cystic masses that can have all of the criteria of category III but

also contain distinct enhancing soft-tissue components independent of the wall

or septa

- % malignant : ~ 100%

- Need to be removed

Diagnosis

Renal Cysts



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