CANCER RISK IN COMPLEX RENAL CYSTS

KIDNEY CYST
THE COMPLEX ONE ARE JUST A HEADACHE BUT BEAR A CANCER RISK
MELISSA HEUER ET AL HELPS!

The risk that a complex kidney cyst is, or may become, a kidney cancer depends on its appearance on radiographic imaging (CT scan or MRI). A system to grade kidney cysts by their appearance on CAT scan has been developed, which help doctors to predict which complex kidney cysts are more likely to have kidney cancer inside. This system is known as the Bosniak classification. The Bosniak classification provides specific definitions to classify cysts by the risk of kidney cancer.

Bosniak Categories of Complex Kidney Cysts

Category	Description	Risk of Kidney Cancer
Category I	A simple benign cyst with a hairline thin wall that does not contain septa, calcifications, or solid components. It measures as water density and does not enhance with contrast material.	0% to < 2%
Category II	A cyst that might contain a few hairline thin septa. Fine calcifications might be present in the wall or septa. Uniformly high-attenuation (hyperdense) lesions of <3 cm that are well marginated and do not enhance.	13.7%
Category IIF	These cysts might contain more hairline thin septa. No measurable enhancement of a hairline thin septum or wall can be seen.  There can be minimal thickening of the septa or wall. The cyst might contain calcifications that are nodular and thick but there is no contrast enhancement. No enhancing soft tissue elements are seen. Totally intrarenal non-enhancing high-attenuation renal lesions equal to or greater than 3 cm are also included in this category. These lesions are generally well marginated.	14.3% to 24%
Category III	These lesions are indeterminate cystic masses that have thickened irregular walls or septa in which enhancement can be measured.	50.8%
Category IV	All of the criteria of category III along with enhancing soft-tissue components adjacent to, but independent of the wall or septum.  These cysts are usually malignant cystic masses.	90.1%

The Bosniak classification above, is designed to help your doctor predict the chances that your complex renal cyst is associated with a kidney cancer. This predictive ability is very important in helping you work with your urologist to determine the best treatment strategy for you.  The risk that your kidney cyst harbors a kidney cancer must be balanced with your overall health to so that a proper treatment strategy can be created.

Bosniak category I complex kidney cysts have a less than 2% chance of being associated with a kidney cancer. Bosniak category II complex kidney cysts have an approximately 14% chance of being associated with kidney cancer.  Bosniak category IIF lesions are complex kidney cysts that have more irregularities and are typically larger than category II cysts.  Also, category IIF cysts do not have measurable enhancement on imaging and therefore do not qualify as category III complex kidney cysts.  The “F” in the IIF designation is meant to suggest “Follow” or observe this cyst rather than perform a procedure such as partial nephrectomy or kidney cryoablation to treat the cyst.  However, the category IIF cysts have a higher rate of malignancy which is up to 24%, and therefore it is important to discuss the merits of treatment versus observation with your urologist.  Bosniak catagory III and category IV complex kidney cysts have a 50% and 90.1% chance respectively of being kidney cancer and are often recommended for surgical removal or treatment with cyst ablation."

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