基于2019版Bosniak分级系统对肾囊性病变的MSCT与病理对照研究  

Correlative study between MSCT and histopathology based on bosniak classification version 2019

作　　者：周航[1] 胡杉[3] 李树荣[2] 姚浩华 陈炜[1] 陈凌武[1] 陈旭[1] ZHOU Hang;HU Shan;LI Shu-rong(Department of Urinary Surgery,the First Affiliated Hospital of Sun Yat-Sen University,Guangzhou 510075,China)

机构地区：[1]中山大学附属第一医院泌尿外科,广州510075 [2]中山大学附属第一医院放射科,广州510075 [3]广东省人民医院(广东省医学科学院)放射科,广州510080

出　　处：《放射学实践》2022年第5期556-559,共4页Radiologic Practice

基　　金：中山大学附属第一医院“第三批优秀青年支持人才计划”(Y50148)。

摘　　要：目的:探讨如何利用2019版Bosniak分级系统,根据MSCT影像诊断结果制定复杂性肾囊性病变的治疗策略。方法:由两位影像科医生根据2019版Bosniak分级系统,独立对MSCT诊断为复杂肾囊性病变的140例患者的图像进行再次评级,并分析其与术后病理良恶性的关联。结果:将不适用于分级的3例病例排除后,137例复杂性肾囊性病变中术后病理为恶性病变者69例(50.3%),良性病变者68例(49.7%)。两位医师根据Bosniak分级系统对于肾恶性病变鉴别的曲线下面积(AUC)分别为0.971(95%CI:0.939~1.003)、0.949(95%CI:0.912~0.987);两位医师诊断的一致性Kappa值为0.597(P<0.001)。对于恶性病变的诊断界值,甲医师为Ⅳ级,诊断敏感度为97.1%,特异度为95.6%;乙医师为ⅡF级,诊断敏感度为97.1%,特异度为82.4%。结论:2019版Bosniak分级系统对恶性肾囊性病变具有良好的诊断效能。由于临床实践中对过渡级别(ⅡF~Ⅲ)病变的报告准确度存在差异,对于影像评级IIF以上的肾囊性肿物,需根据实际情况谨慎考虑处理策略,尽可能避免肿瘤种植和贻误治疗时机。Objective:To formulate the treatment strategy of complex renal cysts according to MSCT diagnosis reasonably with bosniak classification.Methods:According to the new Bosniak classification,two radiologists independently rated the 140 cases of MSCT diagnosed as complex renal cyst,and analyzed theirs correlation with postoperative pathological benign and malignant.Results:After excluding 3 cases that were not suitable for classification,69 cases(50.3%)of 137 cases were malignant tumors,68 cases(49.7%)were benign tumors.According to the Bosniak classification,the diagnostic AUC values of the two radiologists for malignant renal tumors were 0.971(95%CI:0.939~1.003)and 0.949(95%CI:0.912~0.987),respectively.The kappa value was 0.597,P<0.001.For the diagnostic cut-off point of malignant tumor,radiologist A was categoryⅣ(sensitivity 97.1%,specificity 95.6%)while radiologist B was categoryⅡF(sensitivity 97.1%,specificity 82.4%).Conclusion:The new Bosniak classification has good diagnostic efficacy for the malignant renal cystic lesions.Due to the difference in reporting accuracy of transition categories(ⅡF~Ⅲ),clinicians need to consider the necessity of surgical treatment for cystic renal masses rated above Bosniak categoryⅡF according to the actual situation,to avoid tumor implantation and delaying the treatment opportunity.

关 键 词：BOSNIAK分级 肾囊性病变 肾肿瘤 体层摄影术 X线计算机 病理学 

分 类 号：R737.11[医药卫生—肿瘤] R814.42[医药卫生—临床医学]