Cystic renal lesions: one centre study

Česká verzia

Authors: Tomáš Pitra ¹; Kristýna Pivovarčíková ²; Radek Tupý ³; Jiří Kolář ¹; Ondřej Hes ²; Milan Hora ¹
Authors place of work: Urologická klinika LF UK a FN, Plzeň ¹; Šiklův ústav patologie LF UK a FN, Plzeň ²; Klinika zobrazovacích metod LF UK a FN Plzeň ³
Published in the journal: Ces Urol 2019; 23(2): 131-139
Category: Original Articles

Byli vyhledáni a opětovně hodnoceni pacienti léčení chirurgicky pro tumor ledviny/ cystickou renální lézi v období 1/2009–12/2017. Ze souboru byli vyčleněni pacienti s cystickou renální lézí úvodně detekovanou radiologicky. Tyto případy byly opětovně revidovány a klasifikovány dle Bosniaka (primárně za užití CT, u nejasných nálezů bylo doplněno vyšetření MR), porovnány byly výsledky histologického vyšetření a možnosti operační terapie.

Summary

Aim: To find the frequency of occurrence of cystic tumours of the kidney, to compare the results of imaging studies with the final histology findings, to retrospectively evaluate possibilities of diagnostics and surgery.

Material a methods: All patients who underwent surgery for the kidney tumour/cystic lesion of the kidney in the time period I/2009-XII/2017 were searched and reevaluated. The patients with cystic renal lesions were included in this study. These patients were reevaluated and classified according to Bosniak (primarily based on CT; ambiguous than an MRI was perfomed. The histological results surgicak options were compared.

Results: In total 1826 patients were included, 247 (14 %) of them with a cystic lesion. Cystic lesions represented 9.8 % of the total amount of neoplasias. Bosniak categories were present as follows Bosniak I in 74 cases (30 %), Bosniak II 13 (5.3 %), Bosniak IIF 28 (11.3 %), Bosniak III 61 (24.7 %) a Bosniak IV 71 (28.7 %). Both CT both MRI were performed in 82 patients (MRI results were the superior).This changed Bosniak classification in 43 patients (52.4 %). Upgrade in Bosniak category in 35 cases (42.7 %) and downgrade in 8 cases (9.7 %). The most frequent type of surgery was nephron-sparing surgery (84.6 %) - 49.4 % resection, 35.2 % ablation. Mini-invasive approach (laparoscopy) in 72.4 %, open surgery in 27.6 %.

Conclusion: Most of the cystic lesions of the kidney can be treated with nephron-sparing surgery. The use of MRI in diagnostics lead to changes in Bosniak classification with direct impact on the next therapeutic management. As a result in our centre we have included MRI in the standard diagnostic algorithm of the cystic lesions in Bosniak IIF and Bosniak III categories.

Keywords:

magnetic resonance – Bosniak – cyst – kidneys – tumour.

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