CUA GL Cystic Renal Lesions 2017

Question 1

What was the original bosniak classification based on?

Answer 1

CT scans

Question 2

What is the next step if a complex cyst is identified on US?

Answer 2

Contrast enhanced CT/MRI(axial imaging)

Question 3

What bosniak class are the majority of cystic renal lesions?

Answer 3

BOSNIAK I

Question 4

what do bosniak I lesions look like on US?

Answer 4

thin-walled, anechoic, posterior enhancement, sharply marinated smooth walls On Ct 0-20 HU

Question 5

What is the risk of malignancy for Bosniak I and II cysts?

Answer 5

I nil, II under 5%

Question 6

What is class IIf cyst?

Answer 6

has several thin speta, can be nodular BUT no enhancement, also hyperdense cysts(>20HU) larger than 3 cm go here too

Question 7

What is the malignancy risk of Bosniak IIF cysts?

Answer 7

8-27%

Question 8

What percentage of Bosniak III cysts malignant?

Answer 8

54%

Question 9

What do bosniak III cysts look like on imaging?

Answer 9

irregular and thickened walls, irregualr septa with calcifications. contrast enhanced septae( usually multiple)

Question 10

What is the unique characteristic of Bosniak IV cysts and what is the risk of malignancy?

Answer 10

Solid contrast enhancing component present, risk of malignancy 88%

Question 11

Do most of class I cysts grow overtime?

Answer 11

yes, that is not a sign of malignancy

Question 12

Is FU needed for bosniak I or II cysts? any exceptions?

Answer 12

NO, if there is any doubt they are II or IIF should then be followed

Question 13

What percentage of IIf cysts progress in complexity?

Answer 13

15%, so FU with CE CT or MRI Q 6 month for 1 year then space out.

Question 14

If you have a patient with IIF cyst that has not changed on serial imaging. how long do you need to follow ?

Answer 14

at least 5 years

Question 15

can you decompress a Bosniak III cyst during partial to facilitate removal?

Answer 15

Yes with low risk of tumor recurrence. do only if required

Question 16

What is another name for cystic RCC?

Answer 16

multilocular cystic renal neoplasm with low malignant potential

Question 17

How does the prognosis of cystic RCC compare to regular Solid RCC?

Answer 17

better prognosis, rarely metastasizes, rare local recurrence

Question 18

What is the role of active S for cystic renal masses III and IV?

Answer 18

emerging evidence it could work but reserve for patients who are poor surgical candidates, do a partial.

Question 19

Cryotherapy for cystic RCC? RFA?

Answer 19

cryotherapy role not defined. RFA only if not fit for surgery or AS and should get a biopsy before treating it. (most helpful for IV where there is a proper solid components, >1cm to get better diagnostic rate)