International urology and nephrology · 2026
Bosniak IIF renal cysts: natural history and the impact of lesion size on progression.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Fernández-Mardomingo Díaz Ana, Artiles Medina Alberto, López Curtis David, Mínguez Ojeda César, Subiela José Daniel, González Tello Fernando, Sanz Mayayo Enrique, De la Parra Sánchez Irene, Gómez Dos Santos Victoria, Burgos Revilla Francisco Javier
Аннотация
PURPOSE: This study aimed to analyze the natural history and radiological progression and malignancy of Bosniak IIF renal cysts based on the 2019 version of the classification.
METHODS: We conducted a single-center retrospective observational study, reviewing radiology reports from CT scans performed between March 2007 and December 2021. The final cohort included 85 patients with at least two imaging studies. Demographic, clinical, and radiological data, including cyst size, septal characteristics, and contrast-enhanced ultrasound (CEUS) findings, were analyzed. Kaplan-Meier survival analysis and Cox regression models were applied to identify potential predictors of cyst progression.
RESULTS: During a median follow-up of 46 months (IQR 30-71), 5 patients (6%) experienced cyst progression: 4 to Bosniak III and 1 to Bosniak IV with simultaneous detection of liver metastases. The median time to progression was 10.3 months (IQR 9-24). Among the four surgically treated cases, histopathological analyses confirmed renal cell carcinoma in two, a multicystic nephroma in one, and a benign lesion in the remaining case. Contrast-enhanced ultrasound (CEUS) was performed in 45% of patients. On univariable analysis, larger cyst size (HR 1.02; 95% CI 1.01-1.04) and septal enhancement on CEUS (HR 12.4; 95% CI 1.28-120.7) were associated with progression.
CONCLUSION: The risk of malignancy in Bosniak IIF cysts remains low, with a malignancy rate of 3.5%. Lesion size appears to be associated with progression, supporting its potential role in informing follow-up strategies. The first year of surveillance seems to be particularly critical, and an early reassessment at 6 months may facilitate the identification of lesions at higher risk of progression.
METHODS: We conducted a single-center retrospective observational study, reviewing radiology reports from CT scans performed between March 2007 and December 2021. The final cohort included 85 patients with at least two imaging studies. Demographic, clinical, and radiological data, including cyst size, septal characteristics, and contrast-enhanced ultrasound (CEUS) findings, were analyzed. Kaplan-Meier survival analysis and Cox regression models were applied to identify potential predictors of cyst progression.
RESULTS: During a median follow-up of 46 months (IQR 30-71), 5 patients (6%) experienced cyst progression: 4 to Bosniak III and 1 to Bosniak IV with simultaneous detection of liver metastases. The median time to progression was 10.3 months (IQR 9-24). Among the four surgically treated cases, histopathological analyses confirmed renal cell carcinoma in two, a multicystic nephroma in one, and a benign lesion in the remaining case. Contrast-enhanced ultrasound (CEUS) was performed in 45% of patients. On univariable analysis, larger cyst size (HR 1.02; 95% CI 1.01-1.04) and septal enhancement on CEUS (HR 12.4; 95% CI 1.28-120.7) were associated with progression.
CONCLUSION: The risk of malignancy in Bosniak IIF cysts remains low, with a malignancy rate of 3.5%. Lesion size appears to be associated with progression, supporting its potential role in informing follow-up strategies. The first year of surveillance seems to be particularly critical, and an early reassessment at 6 months may facilitate the identification of lesions at higher risk of progression.