The current nosology on renal cysts: Bosniak III or IV?

González Enguita, C.; Simón Rodríguez, C.; Vela Navarrete, R.

doi:10.1016/j.acuroe.2019.06.001

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"tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "519" "paginaFinal" => "520" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "C. González Enguita, C. Simón Rodríguez, R. Vela Navarrete" "autores" => array:3 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "González Enguita" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Simón Rodríguez" ] 2 => array:4 [ "nombre" => "R." "apellidos" => "Vela Navarrete" "email" => array:1 [ 0 => "RVela@fjd.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Fundacion Jimenez Diaz, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El Debate del Bosniak 3 o 4 y La vigente nosología quística" ] ] "textoCompleto" => "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 (CT).<a class="elsevierStyleCrossRef" href="#bib0005">1</a> The Bosniak classification is based on the detailed semiotics provided by CT; contour and contents, presence of septations and/or calcifications, enhancement after contrast agent injection and Hounsfield units.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>Cystic processes with tumor suspicion are rated Bosniak III or IV and simple renal cysts are I or II. The assessment is strictly radiological, and the terminology is exclusively numerical. In the presence of disease, the final diagnosis is reduced to 2 options: clear cell renal cell carcinoma (CCRCC) or simple/benign renal cyst.CT has facilitated the diagnosis of many renal cystic processes, thus, avoiding unnecessary exploratory surgeries. The Bosniak classification has been, and still is, extraordinarily valid. However, numerical classification has limitations: it is not inerrable, it is incomplete and confusing due to the exclusion of conventional anatomo-clinical terminology. A recent publication<a class="elsevierStyleCrossRef" href="#bib0015">3</a> paradigmatically confirms these limitations: the classification of categories III and IV did not improve when the cystic volume assessment was added, still obtaining similar results for both categories of CCRCC. The second limitation is related to the answer to this question: What diseases that present renal cysts, benign or malignant, have been included in this series? There is not one single reference to common urology terms in the text, but the authors present 6 images; one is typical of multicystic kidney; another one shows polycystic disease of the renal sinus but described as a “subtype of benign cyst.”This extensive study confirms that the population included, of unknown nosological identity, is very heterogeneous. Despite multiple publications, other cystic diseases (parapelvic cysts, polycystic disease of the renal sinus) remain unknown in the literature.<a class="elsevierStyleCrossRefs" href="#bib0020">4,5</a> It also acknowledges that the unavoidable and more rigorous implementation to Bosniak, is provided by the clinician, in this case the urologist, positioning, not only the cyst, but the patient as well, in the correct anatomo-clinical definition. Actually, the CCRCC can correspond to different processes such as the multicystic dysplastic kidney (anomaly of the kidney of reduced recognizable malignancy in childhood) or the von Hippel-Lindau (systemic inherited disorder of extreme recognizable gravity in adulthood), and a benign cyst can be cortical or parapelvic, with different (renal or lymphatic) origin and clinical consequences.In our clinical practice, the radiological identity proposed by Bosniak needs to add the nosological, anatomo-clinical surname from the conventional terminology, which is being ignored or avoided in the current radiological literature." "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-06-07" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: González Enguita C, et al. El debate del Bosniak 3 o 4 y la vigente nosología quística. Actas Urol Esp. 2019;43:519–520." ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The current radiological approach to renal cysts" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M.A. Bosniak" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1148/radiology.158.1.3510019" "Revista" => array:6 [ "tituloSerie" => "Radiology" "fecha" => "1986" "volumen" => "158" "paginaInicial" => "1" "paginaFinal" => "10" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3510019" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosis and management of patients with complicated cystic lesions of the kidney" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M.A. Bosniak" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Roentgenol" "fecha" => "1997" "volumen" => "169" "paginaInicial" => "819" "paginaFinal" => "821" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cystic renal cell carcinoma: a report on outcomes of surgery and active surveillance in patients retrospectively identified on pretreatment imaging" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Kashan" 1 => "M. Ghanaat" 2 => "A.M. Hötker" 3 => "C. Duzgol" 4 => "A. Sanchez" 5 => "R.G. DiNatale" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Urol" "fecha" => "2018" "volumen" => "200" "paginaInicial" => "275" "paginaFinal" => "282" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Polycystic disease of the renal sinus: structural characteristic" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. Vela Navarrete" 1 => "A. García Robledo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0022-5347(17)52319-8" "Revista" => array:6 [ "tituloSerie" => "J Urol" "fecha" => "1983" "volumen" => "129" "paginaInicial" => "700" "paginaFinal" => "703" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6842686" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Poliquistosis del seno renal o hilioquistosis. Controversias, retos e historia de un descubrimiento compartido" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Simón Rodríguez" 1 => "C. Gonzalez Enguita" 2 => "R. Vela Navarrete" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.acuro.2018.03.006" "Revista" => array:6 [ "tituloSerie" => "Actas Urol Esp" "fecha" => "2018" "volumen" => "42" "paginaInicial" => "611" "paginaFinal" => "664" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29910138" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735786/0000004300000010/v1_201912120813/S2173578619301179/v1_201912120813/en/main.assets" "Apartado" => array:4 [ "identificador" => "48580" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Editorials" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735786/0000004300000010/v1_201912120813/S2173578619301179/v1_201912120813/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578619301179?idApp=UINPBA00004N"]

ISSN: 2173-5786

Actas Urológicas Españolas is an international journal dedicated to urological diseases and renal transplant. It has been the official publication of the Spanish Urology Association since 1974 and of the American Urology Confederation since 2008. Its articles cover all aspects related to urology. Actas Urológicas Españolas, governed by the peer review system (double blinded), is published online in Spanish and English. Consequently, manuscripts may be sent in Spanish or English and bidirectional free cost translation will be provided. It has high visibility and accessibility and is found in the most important data bases, Medline/Pubmed, Emabase, JCR, Ïndice Médico Español, Índice bibliográfico Español en Ciencias de la Salud (IBECS), Cuiden, Dialnet, Hinari, Scopus, Google Scholar.

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