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The current nosology on renal cysts: Bosniak III or IV?
El Debate del Bosniak 3 o 4 y La vigente nosología quística
C. González Enguita, C. Simón Rodríguez, R. Vela Navarrete
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RVela@fjd.es

Corresponding author.
Fundacion Jimenez Diaz, Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">During the last 30 years the classification system of renal cystic processes proposed by Bosniak has been a common resource to define any renal cyst evaluated by computed tomography &#40;CT&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The Bosniak classification is based on the detailed semiotics provided by CT&#59; contour and contents&#44; presence of septations and&#47;or calcifications&#44; enhancement after contrast agent injection and Hounsfield units&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Cystic processes with tumor suspicion are rated Bosniak III or IV and simple renal cysts are I or II&#46; The assessment is strictly radiological&#44; and the terminology is exclusively numerical&#46; In the presence of disease&#44; the final diagnosis is reduced to 2 options&#58; clear cell renal cell carcinoma &#40;CCRCC&#41; or simple&#47;benign renal cyst&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">CT has facilitated the diagnosis of many renal cystic processes&#44; thus&#44; avoiding unnecessary exploratory surgeries&#46; The Bosniak classification has been&#44; and still is&#44; extraordinarily valid&#46; However&#44; numerical classification has limitations&#58; it is not inerrable&#44; it is incomplete and confusing due to the exclusion of conventional anatomo-clinical terminology&#46; A recent publication<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> paradigmatically confirms these limitations&#58; the classification of categories III and IV did not improve when the cystic volume assessment was added&#44; still obtaining similar results for both categories of CCRCC&#46; The second limitation is related to the answer to this question&#58; What diseases that present renal cysts&#44; benign or malignant&#44; have been included in this series&#63; There is not one single reference to common urology terms in the text&#44; but the authors present 6 images&#59; one is typical of multicystic kidney&#59; another one shows polycystic disease of the renal sinus but described as a &#8220;subtype of benign cyst&#46;&#8221;</p><p id="par0020" class="elsevierStylePara elsevierViewall">This extensive study confirms that the population included&#44; of unknown nosological identity&#44; is very heterogeneous&#46; Despite multiple publications&#44; other cystic diseases &#40;parapelvic cysts&#44; polycystic disease of the renal sinus&#41; remain unknown in the literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a> It also acknowledges that the unavoidable and more rigorous implementation to Bosniak&#44; is provided by the clinician&#44; in this case the urologist&#44; positioning&#44; not only the cyst&#44; but the patient as well&#44; in the correct anatomo-clinical definition&#46; Actually&#44; the CCRCC can correspond to different processes such as the multicystic dysplastic kidney &#40;anomaly of the kidney of reduced recognizable malignancy in childhood&#41; or the von Hippel-Lindau &#40;systemic inherited disorder of extreme recognizable gravity in adulthood&#41;&#44; and a benign cyst can be cortical or parapelvic&#44; with different &#40;renal or lymphatic&#41; origin and clinical consequences&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In our clinical practice&#44; the radiological identity proposed by Bosniak needs to add the nosological&#44; anatomo-clinical surname from the conventional terminology&#44; which is being ignored or avoided in the current radiological literature&#46;</p></span>"
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¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos