Torbiele nerek – Epidemiologia

Torbiele nerek
Epidemiologia

Torbiele nerek są powszechnym schorzeniem, którego częstość wzrasta z wiekiem – proste torbiele występują u około 25% osób powyżej 40. roku życia i do 50% osób powyżej 50. roku życia. Proste torbiele stanowią 65-70% wszystkich zmian torbielowatych i zazwyczaj są bezobjawowe, wykrywane przypadkowo w badaniach obrazowych (około 40% pacjentów poddawanych TK). Wśród chorób torbielowatych najczęstsza jest autosomalnie dominująca wielotorbielowatość nerek (ADPKD) z częstością 1:2500 do 1:1000, prowadząca u 50% pacjentów do schyłkowej niewydolności nerek do 70. roku życia. Nabyta choroba torbielowata nerek (ACKD) rozwija się u 44-90% pacjentów dializowanych przez 3-10 lat. Klasyfikacja Bosniaka (I-IV) służy do oceny złożoności torbieli i ryzyka złośliwości, gdzie torbiele I i II zwykle nie wymagają leczenia, IIF wymagają monitorowania przez około 5 lat, a III i IV tradycyjnie kwalifikują się do leczenia chirurgicznego ze względu na ryzyko złośliwości odpowiednio około 50% i 80-90%.

Epidemiologia torbieli nerek

Częstotliwość występowania różnych typów torbieli nerek
Nabyta choroba torbielowata nerek

Nadzór nad torbielami nerek

Aktywny nadzór nad małymi guzami nerkowymi
Nadzór nad złożonymi torbielami nerkowymi
Strategie nadzoru i obserwacji

Znaczenie nadzoru w zapobieganiu rozwojowi choroby

Rola aktywnego nadzoru w zapobieganiu nadmiernemu leczeniu
Badania potwierdzające skuteczność nadzoru
Wyzwania i bariery w nadzorze nad torbielami nerkowymi

Przyszłość nadzoru nad torbielami nerkowymi

Bieżące badania i inicjatywy
Potencjalne zmiany w wytycznych klinicznych
Zaawansowane techniki obrazowania i ich rola w nadzorze

Implikacje dla zdrowia publicznego

Koszty i efektywność różnych strategii nadzoru
Wpływ na jakość życia pacjentów
Wytyczne dla lekarzy i pracowników służby zdrowia
Kolejne rozdziały

Epidemiologia torbieli nerek

Torbiele nerek są niezwykle powszechnym schorzeniem, a ich częstość występowania zwiększa się wraz z wiekiem. Około 25% osób w wieku 40 lat lub starszych oraz około 50% osób w wieku 50 lat i starszych ma proste torbiele nerek¹². W badaniach autopsyjnych wykazano, że około 50% osób starszych niż 50 lat ma jedną lub więcej torbieli nerek, a inne badania wskazują, że prawie jedna trzecia osób w tej grupie wiekowej ma co najmniej jedną torbiel nerki, którą można zidentyfikować w badaniu tomografii komputerowej³. Według innych źródeł, torbiele nerek występują u około 5% populacji ogólnej, wzrastając w częstości do 25-33% u pacjentów powyżej 50 roku życia⁴.

Choć torbiele nerek są najczęściej wykrywane u osób starszych, mogą pojawić się w każdym wieku. W populacji pediatrycznej częstość występowania prostych torbieli nerek jest stosunkowo niska i wynosi od 0,22% do 1%, w zależności od badania⁵. Jest to znacznie niższy wskaźnik niż u dorosłych, co potwierdza zależność między wiekiem a częstością występowania torbieli nerek.

Częstotliwość występowania różnych typów torbieli nerek

Proste torbiele nerek stanowią około 65-70% wszystkich zmian torbielowatych nerek⁶. Są one zwykle przypadkowo odkrywane i najczęściej nie powodują objawów. Badania pokazują, że obecność torbieli nerkowych wykrywanych w badaniach radiologicznych dotyczy około 40% wszystkich osób poddawanych tomografii komputerowej⁷.

Częstość występowania autosomalnie dominującej wielotorbielowatości nerek (ADPKD), która jest najczęstszą dziedziczną chorobą nerek i najczęstszą chorobą torbielowatą nerek ogółem, wynosi około 1 na 2500 osób w Europie⁸ do 1 na 1000 osób na świecie, dotykając około 12,5 miliona osób, głównie dorosłych⁹¹⁰. ADPKD jest również jedną z najczęstszych przyczyn schyłkowej niewydolności nerek u dorosłych, gdzie 50% dotkniętych osób rozwija niewydolność nerek do 70 roku życia¹¹.

Autosomalnie recesywna wielotorbielowatość nerek (ARPKD) występuje znacznie rzadziej, z częstością około 1 na 20 000 noworodków¹² do 1 na 6000-55 000 żywych urodzeń¹³. Jest to głównie diagnozowane w niemowlęctwie, dzieciństwie lub okresie dojrzewania i stanowi przyczynę 5% przypadków schyłkowej choroby nerek (ESRD) u dzieci i dorosłych¹⁴.

Nabyta choroba torbielowata nerek

Nabyta choroba torbielowata nerek (ACKD) rozwija się wtórnie do dializy¹⁵. Częstość występowania ACKD jest ściśle związana z czasem trwania niewydolności nerek i następującego po niej leczenia dializacyjnego. Torbiele rozwijają się u około 8-13% pacjentów z przewlekłą niewydolnością nerek przed rozpoczęciem dializoterapii¹⁶¹⁷.

U pacjentów dializowanych przez 3 lata, 5 lat i 10 lub więcej lat, częstość występowania ACKD wzrasta odpowiednio z 44% do 60% do 90%¹⁸¹⁹. Jest to równie powszechne zarówno w hemodializie, jak i dializie otrzewnowej²⁰. Choroba ta wydaje się ustępować po udanym przeszczepie nerki²¹.

Nadzór nad torbielami nerek

Nadzór nad torbielami nerek, szczególnie nad torbielami złożonymi, staje się coraz bardziej istotnym elementem postępowania klinicznego. Większość zmian nerkowych przypadkowo wykrytych w badaniach przekrojowych to torbiele, które są głównie łagodne, a jeśli są złośliwe, to zazwyczaj mają ograniczony potencjał przerzutowy²².

Aktywny nadzór nad małymi guzami nerkowymi

Aktywny nadzór (AS) definiuje się jako początkowe postępowanie obejmujące monitorowanie wielkości guza nerki²³. Jest to obecnie opcja zgodna z wytycznymi urologicznymi, szczególnie w przypadku małych guzów nerkowych (SRM), które są określane jako wzmocnione masy nerkowe o wielkości mniejszej niż 4 cm²⁴.

AS jest zalecany w następujących sytuacjach:

Dla pacjentów z guzami nerkowymi podejrzanymi o nowotwór, zwłaszcza tymi mniejszymi niż 2 cm²⁵
W przypadku przewlekłej choroby nerek lub u pacjentów z jedną nerką, gdzie można rozważyć okres obserwacji²⁶
Gdy przewidywane ryzyko interwencji lub konkurujące ryzyko zgonu przewyższa potencjalne korzyści onkologiczne aktywnego leczenia²⁷

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Bezwzględne wskazania do AS według wytycznych ASCO to wysokie ryzyko związane ze znieczuleniem i interwencją lub oczekiwana długość życia krótsza niż 5 lat²⁹.

Nadzór nad złożonymi torbielami nerkowymi

Złożoność torbieli nerkowych klasyfikuje się za pomocą systemu klasyfikacji torbieli nerkowych Bosniaka, który został pierwotnie zastosowany w tomografii komputerowej i rezonansie magnetycznym, a ostatnio również w ultrasonografii z kontrastem (CEUS)³⁰.

Zgodnie z systemem klasyfikacji Bosniaka:

Torbiele typu IIF powinny być monitorowane³¹
Dla torbieli typu III i IV tradycyjnie wskazana jest operacja, mimo świadomości, że 50% torbieli Bosniaka III jest łagodnych³²

³³

Jednak coraz więcej dowodów sugeruje, że znaczna część torbieli Bosniaka III i IV jest łagodna, a te złośliwe wykazują niski potencjał przerzutowy³⁴³⁵. Ponieważ operacja nerki wiąże się ze znaczną chorobowością (20%) i potencjalną śmiertelnością (0,5%), aktywny nadzór zyskał uwagę jako potencjalna alternatywa dla operacji w celu uniknięcia nadmiernego leczenia³⁶.

Badania wskazują, że możliwe jest oferowanie AS pacjentom z postępującymi torbielami Bosniaka IIF lub Bosniaka III jako alternatywy dla operacji w określonych scenariuszach klinicznych, podobnych do pacjentów z SRM³⁷. Wielkość złożonych torbieli nerkowych nie ma korelacji z częstością występowania raka nerkowokomórkowego (RCC) ani z agresywnością guza, a niedawne badanie wykazało, że złośliwe torbiele są mniejsze niż łagodne³⁸.

Strategie nadzoru i obserwacji

Strategie nadzoru nad torbielami nerkowymi różnią się w zależności od rodzaju torbieli:

Proste torbiele nerkowe (Bosniak I) zwykle nie wymagają leczenia ani obserwacji, chyba że powodują objawy. Wytyczne Kanadyjskiego Stowarzyszenia Urologicznego z 2019 roku potwierdzają, że proste torbiele nerkowe są powszechne, prawie nigdy nie dają objawów bez względu na rozmiar, a ich naturalną historią jest wzrost w czasie, co nie powinno być koniecznie uważane za oznakę złośliwości. Co najważniejsze, przekształcenie w bardziej złożoną torbiel jest bardzo rzadkie, a obserwacja nie jest konieczna ani zalecana³⁹.

Torbiele Bosniaka II są nieco bardziej złożone, ale postępowanie jest zasadniczo takie samo, jak w przypadku torbieli Bosniaka I⁴⁰.

Torbiele Bosniaka IIF stanowią pośrednią klasę torbieli, których nie można jednoznacznie zaklasyfikować do kategorii II lub III⁴¹. Badania wskazują, że około 30% torbieli Bosniaka IIF jest zagrożonych złośliwością; w związku z tym przedłużony monitoring przez około 5 lat powinien być standardową formą leczenia⁴². Częstotliwość badań obrazowych w przypadku zmian Bosniaka IIF waha się, w zależności głównie od zrozumienia urologów i radiologów⁴³.

Torbiele Bosniaka III mają około 50% prawdopodobieństwa złośliwości i generalnie zaleca się chirurgiczne wycięcie⁴⁴. Jednak niedawne badania sugerują, że aktywny nadzór może być bezpieczny u wybranych pacjentów z torbielami Bosniaka III⁴⁵⁴⁶.

Torbiele Bosniaka IV mają 80-90% prawdopodobieństwo złośliwości, zazwyczaj torbielowaty rak nerkowokomórkowy. Wycięcie jest leczeniem z wyboru, choć ponieważ większość ma niski potencjał przerzutowy, można rozważyć zachowawcze postępowanie⁴⁷. Badania potwierdzają operację jako podstawowe początkowe leczenie dla pacjentów z Bosniakiem IV ze względu na związany z nim wysoki wskaźnik złośliwości⁴⁸⁴⁹.

W przypadku nabytej choroby torbielowatej nerek (ACKD), obrazowanie przesiewowe jest kontrowersyjne⁵⁰. Jedna strategia przesiewowa obejmuje obrazowanie pacjentów w wieku powyżej 55 lat, którzy są dializowani od trzech lat⁵¹.

Znaczenie nadzoru w zapobieganiu rozwojowi choroby

Aktywny nadzór odgrywa kluczową rolę w zarządzaniu torbielami nerkowymi, szczególnie w kontekście zapobiegania nadmiernemu leczeniu i zachowania funkcji nerek przy jednoczesnym zapewnieniu optymalnej kontroli onkologicznej.

Rola aktywnego nadzoru w zapobieganiu nadmiernemu leczeniu

Częstość występowania raka nerki podwoiła się w USA, jednak wskaźniki śmiertelności pozostają na tym samym poziomie, co sugeruje nadmierne diagnozowanie klinicznie nieistotnych nowotworów nerki⁵². Niedawne aktualizacje wytycznych z różnych organizacji medycznych sugerują zmianę w postępowaniu z torbielami nerkowymi w kierunku bardziej zachowawczego podejścia⁵³.

Badania wykazały, że mimo stosunkowo wysokiego odsetka choroby wysokiego stopnia złośliwości w wyciętych zmianach torbielowatych, aktywny nadzór z opóźnioną interwencją lub bez niej wydaje się bezpieczny i skuteczny dla większości radiograficznie torbielowatych mas nerkowych⁵⁴. W jednym z dużych badań retrospektywnych stwierdzono, że 23% z 387 radiograficznie potwierdzonych zmian torbielowatych wykazywało patologię wysokiego stopnia, ale nie wpłynęło to na ogólne przeżycie, które było podobne zarówno u pacjentów, którzy przeszli natychmiastową operację, jak i u tych, którzy zdecydowali się na AS⁵⁵.

Wyniki te kwestionują historyczne założenia dotyczące natury biologicznie heterogenicznych zmian torbielowatych⁵⁶. W szczególności masy torbielowate są kandydatami do odpowiedniej deeskalacji opieki⁵⁷. Torbielowaty rak nerkowokomórkowy (cRCC) obejmuje spektrum zmian zawierających histologie łagodne i złośliwe⁵⁸.

Badania potwierdzające skuteczność nadzoru

Liczne badania potwierdzają skuteczność aktywnego nadzoru w zarządzaniu torbielami nerkowymi:

Patologicznie potwierdzony cRCC ma przeżycie wolne od nawrotu zbliżone do 100%, a masy torbielowate mają lepsze wyniki przy AS w porównaniu z masami litymi⁵⁹
Postęp przerzutowy w torbielach Bosniaka IIF-IV jest rzadki, a AS nie zwiększa ryzyka rozsiewu przerzutów ani śmiertelności specyficznej dla raka⁶⁰⁶¹
Przeżycie specyficzne dla raka było podobne dla pacjentów, którzy przeszli operację lub ablację (99%) w porównaniu do tych na AS (100%)⁶²

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Te wyniki wspierają bezpieczeństwo AS w torbielach Bosniaka IIF i III oraz potwierdzają operację jako podstawowe początkowe leczenie dla pacjentów z Bosniakiem IV ze względu na związany z nim wysoki wskaźnik złośliwości⁶⁵.

Wyzwania i bariery w nadzorze nad torbielami nerkowymi

Pomimo rosnących dowodów na skuteczność aktywnego nadzoru, wciąż istnieją pewne wyzwania i bariery w jego szerszym przyjęciu. Badanie ankietowe przeprowadzone wśród kanadyjskich urologów wykazało, że mimo włączenia aktywnego nadzoru jako opcji postępowania do wytycznych, wielu lekarzy niechętnie oferuje nadzór pacjentom z torbielami Bosniaka III lub IV⁶⁶.

Najczęściej zgłaszane bariery to:

Obawy pacjentów i lekarzy dotyczące bezpieczeństwa onkologicznego i/lub korzyści z aktywnego nadzoru (89,8%)⁶⁷
Brak danych wspierających aktywny nadzór u pacjentów z torbielami Bosniaka III-IV (74,2%)⁶⁸
Brak konkretnych przesłanek do interwencji podczas nadzoru nad złożonymi torbielami nerkowymi (75,8%)⁶⁹

⁷⁰

Badanie to potwierdza, że mimo braku wysokiej jakości dowodów, wielu kanadyjskich urologów oferuje aktywny nadzór jako opcję pacjentom ze złożonymi torbielami nerkowymi, zwłaszcza jeśli mają torbiel Bosniaka III. Jednak brak wystarczających danych lub wytycznych dotyczących bezpieczeństwa wydaje się zapobiegać szerokiemu przyjęciu aktywnego nadzoru⁷¹.

Przyszłość nadzoru nad torbielami nerkowymi

Przyszłość nadzoru nad torbielami nerkowymi charakteryzuje się ciągłym rozwojem technik obrazowania, gromadzeniem danych z długoterminowych badań oraz potencjalnymi zmianami w wytycznych klinicznych.

Bieżące badania i inicjatywy

Jednym z najbardziej obiecujących bieżących badań jest badanie SOCRATIC, wieloośrodkowy projekt prowadzący prospektywne badanie z 5-letnim okresem obserwacji w celu potwierdzenia wyników onkologicznych aktywnego nadzoru w zarządzaniu złożonymi torbielami⁷²⁷³.

Główne cele tego badania to:

Porównanie 5-letniego przeżycia specyficznego dla raka między torbielami leczonymi chirurgicznie a aktywnym nadzorem⁷⁴⁷⁵
Ocena progresji choroby⁷⁶⁷⁷
Ocena samopoczucia pacjenta w zależności od każdej strategii postępowania⁷⁸⁷⁹
Porównanie 5-letnich kosztów opieki zdrowotnej dla obu podejść⁸⁰⁸¹

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Pacjenci objęci aktywnym nadzorem będą również oceniani pod kątem progresji torbieli i może być im oferowana terapia inwazyjna lub systemowa, jeśli zaobserwuje się progresję⁸⁴.

Potencjalne zmiany w wytycznych klinicznych

Ostatnie dowody sugerują, że poprawa zrozumienia klinicznego postępowania z małymi guzami nerkowymi (SRM) i lepsza znajomość naturalnej historii torbieli nerkowych zwiększyły zaufanie do bardziej zachowawczego podejścia charakteryzującego się aktywnym nadzorem w postępowaniu z torbielami Bosniaka III i IV⁸⁵.

Wytyczne przyjęły AS jako alternatywę dla zarządzania złożonymi torbielami nerkowymi Bosniaka III i IV⁸⁶. Właściwy wybór pacjenta, uwzględniający potencjalne korzyści onkologiczne i konkurencyjne ryzyka zgonu, jest kluczem do zapewnienia odpowiedniego leczenia torbieli Bosniaka III i IV⁸⁷.

Zaawansowane techniki obrazowania i ich rola w nadzorze

Badania obrazowe odgrywają kluczową rolę nie tylko w diagnostyce, ale także w ocenie powikłań i długoterminowej obserwacji torbieli nerkowych⁸⁸. Obrazowanie MR oparte na wolumetrii torbieli nerkowych jest ważnym narzędziem do monitorowania postępu choroby i oceny odpowiedzi na leczenie, zanim funkcja nerek zacznie się pogarszać⁸⁹.

Ciągły wzrost całkowitej objętości nerek i torbieli wskazuje na progresję choroby⁹⁰. Badania przekrojowe obrazowania nie tylko pomagają w wykrywaniu i różnicowaniu różnych przewlekłych dorosłych chorób torbielowatych nerek, ale także odgrywają znaczącą rolę w nadzorze i obserwacji pacjentów⁹¹.

Stosowanie ultrasonografii z kontrastem (CEUS) może pomóc w różnicowaniu łagodnych zmian nerkowych, a tym samym zwiększyć liczbę zmian, które nie wymagają obserwacji⁹². Ponadto, obrazowanie metodą CEUS może być opłacalną opcją dla aktywnego nadzoru nad złożonymi masami nerkowymi, zwłaszcza masami torbielowatymi⁹³.

Implikacje dla zdrowia publicznego

Rosnąca częstość występowania torbieli nerkowych, zwłaszcza wśród starzejącej się populacji, ma znaczące implikacje dla zdrowia publicznego, szczególnie w kontekście strategii badań przesiewowych, kosztów opieki zdrowotnej i jakości życia pacjentów.

Koszty i efektywność różnych strategii nadzoru

Torbielowate masy nerkowe są niezwykle częstymi przypadkowymi znaleziskami w badaniach obrazowych. Znaczna część z nich pozostaje nieokreślona i w odpowiednich okolicznościach klinicznych może być zarządzana przez aktywny nadzór⁹⁴. Najnowsza literatura sugeruje, że nawet te złożone torbiele są często łagodne i wolno rosnące⁹⁵.

Precyzyjna stratyfikacja tych torbieli nerkowych jest krytyczna dla aktywnego nadzoru, ponieważ błędna diagnoza może prowadzić do niedodiagnozowania lub nadmiernego leczenia z potencjalną szkodą dla pacjenta oraz niewłaściwego podziału i wykorzystania zasobów finansowych⁹⁶.

Badanie SOCRATIC ma na celu porównanie 5-letnich kosztów opieki zdrowotnej dla podejścia chirurgicznego i aktywnego nadzoru w zarządzaniu złożonymi torbielami nerkowymi⁹⁷⁹⁸. Wyniki tego badania mogą mieć istotne implikacje dla polityki zdrowotnej i alokacji zasobów w przyszłości.

Wpływ na jakość życia pacjentów

Aktywny nadzór (AS) jako alternatywa dla operacji może mieć znaczący wpływ na jakość życia pacjentów z torbielami nerkowymi. Badanie SOCRATIC ma na celu ocenę samopoczucia pacjenta w zależności od każdej strategii postępowania – chirurgicznej lub aktywnego nadzoru⁹⁹¹⁰⁰.

Ponieważ operacja nerki wiąże się ze znaczną chorobowością (20%) i potencjalną śmiertelnością (0,5%), aktywny nadzór może oferować lepszą jakość życia dla pacjentów, unikając niepotrzebnych interwencji chirurgicznych w przypadkach, gdy torbiele są łagodne lub mają niski potencjał przerzutowy¹⁰¹.

Wytyczne dla lekarzy i pracowników służby zdrowia

Odpowiednia wiedza i zrozumienie naturalnej historii torbieli nerkowych są kluczowe dla lekarzy i pracowników służby zdrowia w podejmowaniu decyzji dotyczących postępowania z pacjentami. Oto kilka kluczowych zaleceń:

Proste torbiele nerkowe (Bosniak I i II) zazwyczaj nie wymagają leczenia ani obserwacji, chyba że powodują objawy¹⁰²
Torbiele Bosniaka IIF wymagają regularnego monitorowania przez około 5 lat¹⁰³
Aktywny nadzór może być bezpieczną opcją dla pacjentów z torbielami Bosniaka III, szczególnie w określonych scenariuszach klinicznych¹⁰⁴¹⁰⁵
Chirurgia pozostaje podstawowym leczeniem dla torbieli Bosniaka IV ze względu na wysoki wskaźnik złośliwości¹⁰⁶¹⁰⁷
Regularna obserwacja jest uzasadniona w przypadku prostych torbieli nerkowych, a większą uwagę należy poświęcić skomplikowanym zmianom podczas nadzoru, ze względu na niezwykle wysokie prawdopodobieństwo złośliwości¹⁰⁸

¹⁰⁹¹¹⁰¹¹¹¹¹²

Te wytyczne mogą pomóc lekarzom w podejmowaniu świadomych decyzji dotyczących postępowania z pacjentami z torbielami nerkowymi, biorąc pod uwagę zarówno ryzyko onkologiczne, jak i potencjalne korzyści z różnych strategii leczenia.

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Materiały źródłowe

#1 Simple Renal Cyst – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK499900/
Simple renal cysts are extremely common, and the incidence increases with age. Approximately 25% of people who are 40 years or older and approximately 50% of people 50 years and older have simple kidney cysts. […] Renal cysts are most often identified at autopsy or incidentally in radiological studies. […] Simple renal cysts can double in size over 10 years. Solitary renal cysts are usually incidentally discovered and are typically asymptomatic. Multiple renal cysts are often seen in patients with chronic renal disease on dialysis.
#2 What Is Simple Kidney Cyst?
https://www.icliniq.com/articles/kidney-and-urologic-diseases/simple-kidney-cyst
Simple renal cysts are very common. Their incidence increases with increasing age. Around 25% of individuals who are forty years or above and around 50% of those who are fifty years or above have simple kidney cysts. […] Simple kidney cysts can double in size over a period of ten years. They are detected accidentally and are usually asymptomatic. More than one simple kidney cyst is seen in individuals with chronic renal disease who are on dialysis.
#3 Evaluation of Incidental Renal and Adrenal Masses | AAFP
https://www.aafp.org/pubs/afp/issues/2001/0115/p288.html
Autopsy results have shown that approximately 50 percent of persons older than 50 years have one or more renal cysts. Other studies indicate that almost one third of persons in this age group have at least one renal cyst that is identifiable on a CT scan. Most of these lesions are benign simple cysts that require no further evaluation, intervention or urologic consultation. […] The primary reason to investigate a renal mass is to exclude a malignant neoplasm. One screening study using ultrasound examinations found clinically or pathologically malignant renal tumors in 12 (0.2 percent) of 5,898 consecutive patients 50 to 79 years of age. The lifetime risk of renal cell carcinoma in a 40-year-old man is 1.34 percent, and the risk of death is slightly greater than 0.5 percent. […] With the proper history and interpretation of the renal ultrasonogram and/or CT scan, family physicians can correctly identify the majority of renal masses, which are simple cysts. They can also identify complex cysts and solid masses, which require further evaluation. Probable benign cysts may undergo surveillance, whereas indeterminate or complex cysts should be referred for surgical evaluation.
#4 Cystic Diseases of the Kidney: Practice Essentials, Pathophysiology, Etiology
https://emedicine.medscape.com/article/453831-overview
VHLS has an incidence of approximately one per 39,000 persons, and two thirds of these individuals develop renal cysts. […] In acquired cystic renal disease, cysts are present in 8-13% of patients with chronic renal failure prior to dialysis, in 10-20% of patients after 3 years of dialysis, in 40-60% after 5 years, and in more than 90% after 10 years. […] MSK has an estimated incidence of one per 5000 persons and is found in approximately 20% of patients with nephrolithiasis. […] Simple cysts are the most common cystic renal lesions; they are present in 5% of the general population, increasing in frequency to 25-33% of patients older than 50 years, and account for 65-70% of renal masses. […] Cystic RCC accounts for fewer than 1% of RCC cases.
#5
https://link.springer.com/article/10.1007/s00467-024-06386-6
The reported prevalence of simple kidney cysts in the pediatric populations is low, but variable. In a large series reported by McHugh et al. of 16,102 children who underwent ultrasonography in the mid-late 1980s, the overall prevalence of simple kidney cysts was 0.22%. […] A more recent, even larger case series reported by Karmazyn et al. of ultrasounds performed on 20,349 children during the period 2003-2011 reported a 1% prevalence of simple solitary kidney cysts. […] The differences in prevalence rates for these two large series likely reflects variation in exclusion criteria as well as factors such as local practice patterns in obtaining abdominal ultrasounds, patient referral base, or technical advances in ultrasonography over the last 3 decades. […] Simple kidney cysts can be diagnosed in children of any age, and in most reported series, they do not show any differences in age at diagnosis. […] The reported distribution of females versus males among pediatric patients identified with simple kidney cysts is variable. […] Simple cysts in children are most commonly detected incidentally, not infrequently when imaging is performed for non-specific symptoms such as acute abdominal pain. […] Interestingly, several studies have noted the predominance of simple cysts in the right upper pole.
#6 Cystic Diseases of the Kidney: Practice Essentials, Pathophysiology, Etiology
https://emedicine.medscape.com/article/453831-overview
VHLS has an incidence of approximately one per 39,000 persons, and two thirds of these individuals develop renal cysts. […] In acquired cystic renal disease, cysts are present in 8-13% of patients with chronic renal failure prior to dialysis, in 10-20% of patients after 3 years of dialysis, in 40-60% after 5 years, and in more than 90% after 10 years. […] MSK has an estimated incidence of one per 5000 persons and is found in approximately 20% of patients with nephrolithiasis. […] Simple cysts are the most common cystic renal lesions; they are present in 5% of the general population, increasing in frequency to 25-33% of patients older than 50 years, and account for 65-70% of renal masses. […] Cystic RCC accounts for fewer than 1% of RCC cases.
#7 Renal cyst | Radiology Reference Article | Radiopaedia.org
https://radiopaedia.org/articles/renal-cyst-1?lang=us
Renal cyst is a catch-all term for epithelial cysts, renal sinus (parapelvic/peripelvic) cysts, or calyceal diverticula. This is likely because these have similar appearances on imaging, and distinguishing them is often clinically inconsequential. […] The frequency of renal cysts increases with age, and they are present in approximately ~40% of all individuals receiving a CT scan. Incidental renal cysts are present in ~0.2% of pediatric patients.
#8 Orphanet: Autosomal dominant polycystic kidney disease
https://www.orpha.net/en/disease/detail/730
Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited renal disease, with estimated prevalence of 1/2,500 in Europe. […] Kidney cysts can be detected by prenatal ultrasound scans. Large hyperechogenic kidneys are also a possible early manifestation. Prenatal genetic testing may be possible in at risk families, where the mutation has been previously identified in a family member.
#9 Renal Cystic Disease – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK554504/
The incidence of RCD depends on the underlying etiology. […] ADPKD is the most common RCD overall, with a prevalence of around 1 per 2500 persons, affecting 12.5 million worldwide, mostly adults. […] ADPKD is also one of the most common causes of adult-onset end-stage kidney disease, with 50% of affected individuals progressing to renal failure by age 70 years. […] ADPKD affects all racial and ethnic groups. […] Because of its delayed and indolent presentation, as many as 50% of affected individuals may go undiagnosed. […] About 10% to 15% of affected individuals will not have a positive family history of the disease. […] ARPKD is a rare ciliopathy with an incidence of 1 per 20,000 infants and a perinatal mortality rate of 30% due to complications of pulmonary hypoplasia. […] In contrast to ADPK, the kidney is enlarged at birth, but around age 3 years, the kidney can start to shrink due to atrophy.
#10 Cystic Diseases of the Kidney: Practice Essentials, Pathophysiology, Etiology
https://emedicine.medscape.com/article/453831-overview
One third of people older than 50 years develop cysts in their kidneys. […] The epidemiology of disorders associated with renal cysts is as follows: MCDK has an incidence of one per 1000-4000 live births. […] ADPKD has an incidence of one per 500-1000 persons, affecting 12.5 million worldwide, and accounts for 8-10% of all cases of end-stage renal disease (ESRD) and 5-10% of renal transplants. […] ARPKD has an incidence of one per 6000-55,000 live births, corresponding to one per 70 unaffected carriers in the general population. […] JNPHP affects one per 5000 persons. […] JNPHP and MCKD account for 10-20% of children with chronic renal failure and for 1-5% of all patients undergoing dialysis or transplantation. […] TS has an incidence of one per 10,000-50,000 persons, and 20-25% of these patients have renal cysts.
#11 Renal Cystic Disease – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK554504/
The incidence of RCD depends on the underlying etiology. […] ADPKD is the most common RCD overall, with a prevalence of around 1 per 2500 persons, affecting 12.5 million worldwide, mostly adults. […] ADPKD is also one of the most common causes of adult-onset end-stage kidney disease, with 50% of affected individuals progressing to renal failure by age 70 years. […] ADPKD affects all racial and ethnic groups. […] Because of its delayed and indolent presentation, as many as 50% of affected individuals may go undiagnosed. […] About 10% to 15% of affected individuals will not have a positive family history of the disease. […] ARPKD is a rare ciliopathy with an incidence of 1 per 20,000 infants and a perinatal mortality rate of 30% due to complications of pulmonary hypoplasia. […] In contrast to ADPK, the kidney is enlarged at birth, but around age 3 years, the kidney can start to shrink due to atrophy.
#12 Renal Cystic Disease – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK554504/
The incidence of RCD depends on the underlying etiology. […] ADPKD is the most common RCD overall, with a prevalence of around 1 per 2500 persons, affecting 12.5 million worldwide, mostly adults. […] ADPKD is also one of the most common causes of adult-onset end-stage kidney disease, with 50% of affected individuals progressing to renal failure by age 70 years. […] ADPKD affects all racial and ethnic groups. […] Because of its delayed and indolent presentation, as many as 50% of affected individuals may go undiagnosed. […] About 10% to 15% of affected individuals will not have a positive family history of the disease. […] ARPKD is a rare ciliopathy with an incidence of 1 per 20,000 infants and a perinatal mortality rate of 30% due to complications of pulmonary hypoplasia. […] In contrast to ADPK, the kidney is enlarged at birth, but around age 3 years, the kidney can start to shrink due to atrophy.
#13 Cystic Diseases of the Kidney: Practice Essentials, Pathophysiology, Etiology
https://emedicine.medscape.com/article/453831-overview
One third of people older than 50 years develop cysts in their kidneys. […] The epidemiology of disorders associated with renal cysts is as follows: MCDK has an incidence of one per 1000-4000 live births. […] ADPKD has an incidence of one per 500-1000 persons, affecting 12.5 million worldwide, and accounts for 8-10% of all cases of end-stage renal disease (ESRD) and 5-10% of renal transplants. […] ARPKD has an incidence of one per 6000-55,000 live births, corresponding to one per 70 unaffected carriers in the general population. […] JNPHP affects one per 5000 persons. […] JNPHP and MCKD account for 10-20% of children with chronic renal failure and for 1-5% of all patients undergoing dialysis or transplantation. […] TS has an incidence of one per 10,000-50,000 persons, and 20-25% of these patients have renal cysts.
#14 Renal Cystic Disease – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK554504/
ARPKD is primarily diagnosed in infancy, childhood, or adolescence and is the cause of 5% of end-stage renal disease (ESRD) in children and adults. […] This rare, autosomal recessive genetic disorder, with the most common variant being juvenile nephronophthisis (JNPHP), has an incidence of 98.3 cases per million births. […] About 10% to 20% of children with JNPHP present with chronic renal failure, and between 1% and 5% of all affected patients ultimately need dialysis or transplantation. […] The estimated population prevalence of this condition is 9 in 1 million births, and it tends to inevitably lead to renal failure later in life, typically between the ages of 30 and 60 years, with an average of 45 years. […] These conditions consist of autosomal-dominant gene mutations with an estimated incidence ranging from 1 in 6,000 to 1 in 10,000 births.
#15 Renal Cystic Disease – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK554504/
The occurrence of renal cysts is secondary to dialysis. […] Typically, these cysts develop in adults, usually after the age of 20 years, and then increase in frequency, occurring in 7% to 10% of the general populace. […] Unilateral variants have a higher incidence, estimated to occur in 1 per 4300 births; bilateral kidney involvement has a reported incidence of 1 per 10,000 births. […] The precise incidence of this etiology is unknown; however, between 3% and 20% of individuals with renal stones are estimated to have medullary sponge kidney. […] These cystic renal anomalies rarely occur, often with only a few cases reported worldwide.
#16 Cystic Diseases of the Kidney: Practice Essentials, Pathophysiology, Etiology
https://emedicine.medscape.com/article/453831-overview
VHLS has an incidence of approximately one per 39,000 persons, and two thirds of these individuals develop renal cysts. […] In acquired cystic renal disease, cysts are present in 8-13% of patients with chronic renal failure prior to dialysis, in 10-20% of patients after 3 years of dialysis, in 40-60% after 5 years, and in more than 90% after 10 years. […] MSK has an estimated incidence of one per 5000 persons and is found in approximately 20% of patients with nephrolithiasis. […] Simple cysts are the most common cystic renal lesions; they are present in 5% of the general population, increasing in frequency to 25-33% of patients older than 50 years, and account for 65-70% of renal masses. […] Cystic RCC accounts for fewer than 1% of RCC cases.
#17 Acquired Cystic Kidney Disease : Epidemiology
https://www.webpathology.com/images/genitourinary/non-neoplastic-kidney/cystic-diseases-of-kidney/58376
Epidemiology: The prevalence and severity of acquired cystic kidney disease (ACKD) are related to the duration of the renal failure and the subsequent use of dialysis. Cysts develop in about 10% of uremic patients before they receive dialysis. In patients on dialysis for 3 years, 5 years, and 10 or more years, the incidence of ACKD increases from 44% to 60% to 90% respectively. Males are affected 3-times more commonly than females. There is no association with the patient age or the cause or renal failure. It may even be seen in children. […] The cysts appear to resolve after successful renal transplantation.
#18 Acquired Cystic Kidney Disease : Epidemiology
https://www.webpathology.com/images/genitourinary/non-neoplastic-kidney/cystic-diseases-of-kidney/58376
Epidemiology: The prevalence and severity of acquired cystic kidney disease (ACKD) are related to the duration of the renal failure and the subsequent use of dialysis. Cysts develop in about 10% of uremic patients before they receive dialysis. In patients on dialysis for 3 years, 5 years, and 10 or more years, the incidence of ACKD increases from 44% to 60% to 90% respectively. Males are affected 3-times more commonly than females. There is no association with the patient age or the cause or renal failure. It may even be seen in children. […] The cysts appear to resolve after successful renal transplantation.
#19 Acquired cystic kidney disease | Radiology Reference Article | Radiopaedia.org
https://radiopaedia.org/articles/acquired-cystic-kidney-disease-1?lang=us
Its incidence increases with the amount of time a patient is azotemic and has been estimated at 44% after three years of dialysis and 90% after ten years of dialysis. […] It is equally common with hemodialysis as with peritoneal dialysis. […] imaging screening for these patients is controversial. […] one screening strategy images patients 55 years old who have been on dialysis for three years.
#20 Acquired cystic kidney disease | Radiology Reference Article | Radiopaedia.org
https://radiopaedia.org/articles/acquired-cystic-kidney-disease-1?lang=us
Its incidence increases with the amount of time a patient is azotemic and has been estimated at 44% after three years of dialysis and 90% after ten years of dialysis. […] It is equally common with hemodialysis as with peritoneal dialysis. […] imaging screening for these patients is controversial. […] one screening strategy images patients 55 years old who have been on dialysis for three years.
#21 Acquired Cystic Kidney Disease : Epidemiology
https://www.webpathology.com/images/genitourinary/non-neoplastic-kidney/cystic-diseases-of-kidney/58376
Epidemiology: The prevalence and severity of acquired cystic kidney disease (ACKD) are related to the duration of the renal failure and the subsequent use of dialysis. Cysts develop in about 10% of uremic patients before they receive dialysis. In patients on dialysis for 3 years, 5 years, and 10 or more years, the incidence of ACKD increases from 44% to 60% to 90% respectively. Males are affected 3-times more commonly than females. There is no association with the patient age or the cause or renal failure. It may even be seen in children. […] The cysts appear to resolve after successful renal transplantation.
#22 Active surveillance of small renal masses | Insights into Imaging | Full Text
https://insightsimaging.springeropen.com/articles/10.1186/s13244-020-00853-y
Most renal masses incidentally detected by cross-sectional images are benign, being mainly cysts, and if they are malignant, they are indolent in nature with limited metastatic potential. […] Enhanced renal masses less than 4cm in size are known as small renal masses (SRMs), and their growth rate (GR) and the possibility of developing metastasis are extremely low. […] Delayed intervention of SRMs by closed and routine imaging follow-up known as active surveillance (AS) is now an option according to urological guidelines. […] Radiologists have a key position in AS management of SRMs even unifocal and multifocal (sporadic or associated with genetic syndromes) and also in the follow-up of complex renal cysts by Bosniak cyst classification system. […] The purpose of this article is to review the indications and management of AS in SRMs, especially focused on specific scenarios, such as complex renal cysts and multifocal renal tumors (sporadic or hereditary).
#23 Active surveillance of small renal masses | Insights into Imaging | Full Text
https://insightsimaging.springeropen.com/articles/10.1186/s13244-020-00853-y
Active surveillance is defined as the initial management including the monitoring of renal tumor size. […] AS is the most adequate treatment approach. […] AS is also considered in chronic kidney disease or individual kidney patients in whom an observation period can be considered. […] AS is an option for initial management in patients with renal masses suspicious for cancer, especially those smaller than 2cm. […] AS or expectant management should be a priority when the anticipated risk of intervention or competing risks of death outweigh the potential oncologic benefits of active treatment. […] The ASCO guidelines define the indications of AS as follows: Absolute indications: high risk for anesthesia and intervention or life expectancy less than 5years. […] In clinical practice, the indication of AS is evaluated individually by tumor boards, with the risk of RCC treatment being balanced with the oncologic results of AS, patient age, comorbidities, and limited life expectancy, and finally, leading to multidisciplinary consensus.
#24 Active surveillance of small renal masses | Insights into Imaging | Full Text
https://insightsimaging.springeropen.com/articles/10.1186/s13244-020-00853-y
Most renal masses incidentally detected by cross-sectional images are benign, being mainly cysts, and if they are malignant, they are indolent in nature with limited metastatic potential. […] Enhanced renal masses less than 4cm in size are known as small renal masses (SRMs), and their growth rate (GR) and the possibility of developing metastasis are extremely low. […] Delayed intervention of SRMs by closed and routine imaging follow-up known as active surveillance (AS) is now an option according to urological guidelines. […] Radiologists have a key position in AS management of SRMs even unifocal and multifocal (sporadic or associated with genetic syndromes) and also in the follow-up of complex renal cysts by Bosniak cyst classification system. […] The purpose of this article is to review the indications and management of AS in SRMs, especially focused on specific scenarios, such as complex renal cysts and multifocal renal tumors (sporadic or hereditary).
#25 Active surveillance of small renal masses | Insights into Imaging | Full Text
https://insightsimaging.springeropen.com/articles/10.1186/s13244-020-00853-y
Active surveillance is defined as the initial management including the monitoring of renal tumor size. […] AS is the most adequate treatment approach. […] AS is also considered in chronic kidney disease or individual kidney patients in whom an observation period can be considered. […] AS is an option for initial management in patients with renal masses suspicious for cancer, especially those smaller than 2cm. […] AS or expectant management should be a priority when the anticipated risk of intervention or competing risks of death outweigh the potential oncologic benefits of active treatment. […] The ASCO guidelines define the indications of AS as follows: Absolute indications: high risk for anesthesia and intervention or life expectancy less than 5years. […] In clinical practice, the indication of AS is evaluated individually by tumor boards, with the risk of RCC treatment being balanced with the oncologic results of AS, patient age, comorbidities, and limited life expectancy, and finally, leading to multidisciplinary consensus.
#26 Active surveillance of small renal masses | Insights into Imaging | Full Text
https://insightsimaging.springeropen.com/articles/10.1186/s13244-020-00853-y
Active surveillance is defined as the initial management including the monitoring of renal tumor size. […] AS is the most adequate treatment approach. […] AS is also considered in chronic kidney disease or individual kidney patients in whom an observation period can be considered. […] AS is an option for initial management in patients with renal masses suspicious for cancer, especially those smaller than 2cm. […] AS or expectant management should be a priority when the anticipated risk of intervention or competing risks of death outweigh the potential oncologic benefits of active treatment. […] The ASCO guidelines define the indications of AS as follows: Absolute indications: high risk for anesthesia and intervention or life expectancy less than 5years. […] In clinical practice, the indication of AS is evaluated individually by tumor boards, with the risk of RCC treatment being balanced with the oncologic results of AS, patient age, comorbidities, and limited life expectancy, and finally, leading to multidisciplinary consensus.
#27 Active surveillance of small renal masses | Insights into Imaging | Full Text
https://insightsimaging.springeropen.com/articles/10.1186/s13244-020-00853-y
Active surveillance is defined as the initial management including the monitoring of renal tumor size. […] AS is the most adequate treatment approach. […] AS is also considered in chronic kidney disease or individual kidney patients in whom an observation period can be considered. […] AS is an option for initial management in patients with renal masses suspicious for cancer, especially those smaller than 2cm. […] AS or expectant management should be a priority when the anticipated risk of intervention or competing risks of death outweigh the potential oncologic benefits of active treatment. […] The ASCO guidelines define the indications of AS as follows: Absolute indications: high risk for anesthesia and intervention or life expectancy less than 5years. […] In clinical practice, the indication of AS is evaluated individually by tumor boards, with the risk of RCC treatment being balanced with the oncologic results of AS, patient age, comorbidities, and limited life expectancy, and finally, leading to multidisciplinary consensus.
#28 Active surveillance of small renal masses | Insights into Imaging | Full Text
https://insightsimaging.springeropen.com/articles/10.1186/s13244-020-00853-y
Active surveillance is defined as the initial management including the monitoring of renal tumor size. […] AS is the most adequate treatment approach. […] AS is also considered in chronic kidney disease or individual kidney patients in whom an observation period can be considered. […] AS is an option for initial management in patients with renal masses suspicious for cancer, especially those smaller than 2cm. […] AS or expectant management should be a priority when the anticipated risk of intervention or competing risks of death outweigh the potential oncologic benefits of active treatment. […] The ASCO guidelines define the indications of AS as follows: Absolute indications: high risk for anesthesia and intervention or life expectancy less than 5years. […] In clinical practice, the indication of AS is evaluated individually by tumor boards, with the risk of RCC treatment being balanced with the oncologic results of AS, patient age, comorbidities, and limited life expectancy, and finally, leading to multidisciplinary consensus.
#29 Active surveillance of small renal masses | Insights into Imaging | Full Text
https://insightsimaging.springeropen.com/articles/10.1186/s13244-020-00853-y
Active surveillance is defined as the initial management including the monitoring of renal tumor size. […] AS is the most adequate treatment approach. […] AS is also considered in chronic kidney disease or individual kidney patients in whom an observation period can be considered. […] AS is an option for initial management in patients with renal masses suspicious for cancer, especially those smaller than 2cm. […] AS or expectant management should be a priority when the anticipated risk of intervention or competing risks of death outweigh the potential oncologic benefits of active treatment. […] The ASCO guidelines define the indications of AS as follows: Absolute indications: high risk for anesthesia and intervention or life expectancy less than 5years. […] In clinical practice, the indication of AS is evaluated individually by tumor boards, with the risk of RCC treatment being balanced with the oncologic results of AS, patient age, comorbidities, and limited life expectancy, and finally, leading to multidisciplinary consensus.
#30 Active surveillance of small renal masses | Insights into Imaging | Full Text
https://insightsimaging.springeropen.com/articles/10.1186/s13244-020-00853-y
Most renal masses incidentally found by cross-sectional imaging are cysts which, according to the Bosniak renal cyst classification system, do not require follow-up. […] The use of contrast-enhanced ultrasound (CEUS) can help to differentiate benign renal lesions and thereby increase the number of lesions that do not need to be followed. […] AS is indicated only in SRMs which are regular in shape since masses with irregular borders are highly suspicious of being an aggressive tumor. […] The complexity of renal cysts is classified using the Bosniak renal cyst classification system, which was first applied in CT and MR and more recently in CEUS. […] According to the Bosniak classification system, a IIF cyst should be followed, while surgery is indicated for Bosniak III and IV cysts, despite the knowledge that 50% of Bosniak III cysts are benign.
#31 Active surveillance of small renal masses | Insights into Imaging | Full Text
https://insightsimaging.springeropen.com/articles/10.1186/s13244-020-00853-y
Most renal masses incidentally found by cross-sectional imaging are cysts which, according to the Bosniak renal cyst classification system, do not require follow-up. […] The use of contrast-enhanced ultrasound (CEUS) can help to differentiate benign renal lesions and thereby increase the number of lesions that do not need to be followed. […] AS is indicated only in SRMs which are regular in shape since masses with irregular borders are highly suspicious of being an aggressive tumor. […] The complexity of renal cysts is classified using the Bosniak renal cyst classification system, which was first applied in CT and MR and more recently in CEUS. […] According to the Bosniak classification system, a IIF cyst should be followed, while surgery is indicated for Bosniak III and IV cysts, despite the knowledge that 50% of Bosniak III cysts are benign.
#32 Active surveillance of small renal masses | Insights into Imaging | Full Text
https://insightsimaging.springeropen.com/articles/10.1186/s13244-020-00853-y
Most renal masses incidentally found by cross-sectional imaging are cysts which, according to the Bosniak renal cyst classification system, do not require follow-up. […] The use of contrast-enhanced ultrasound (CEUS) can help to differentiate benign renal lesions and thereby increase the number of lesions that do not need to be followed. […] AS is indicated only in SRMs which are regular in shape since masses with irregular borders are highly suspicious of being an aggressive tumor. […] The complexity of renal cysts is classified using the Bosniak renal cyst classification system, which was first applied in CT and MR and more recently in CEUS. […] According to the Bosniak classification system, a IIF cyst should be followed, while surgery is indicated for Bosniak III and IV cysts, despite the knowledge that 50% of Bosniak III cysts are benign.
#33 Active surveillance of small renal masses | Insights into Imaging | Full Text
https://insightsimaging.springeropen.com/articles/10.1186/s13244-020-00853-y
Most renal masses incidentally found by cross-sectional imaging are cysts which, according to the Bosniak renal cyst classification system, do not require follow-up. […] The use of contrast-enhanced ultrasound (CEUS) can help to differentiate benign renal lesions and thereby increase the number of lesions that do not need to be followed. […] AS is indicated only in SRMs which are regular in shape since masses with irregular borders are highly suspicious of being an aggressive tumor. […] The complexity of renal cysts is classified using the Bosniak renal cyst classification system, which was first applied in CT and MR and more recently in CEUS. […] According to the Bosniak classification system, a IIF cyst should be followed, while surgery is indicated for Bosniak III and IV cysts, despite the knowledge that 50% of Bosniak III cysts are benign.
#34 Surveillance of Complex Renal Cysts – the SOCRATIC Study | Clinical Research Trial Listing
https://www.centerwatch.com/clinical-trials/listings/NCT04558593/surveillance-of-complex-renal-cysts-the-socratic-study
One third of individuals aged 60 years will be diagnosed with at least one renal cyst following abdominal imaging. […] Growing evidence suggests that a significant proportion of Bosniak III and IV cysts are benign and that the malignant ones present low metastatic potential. […] Therefore, prospective studies of long-term follow-up are needed to confirm the oncologic safety of this strategy for patients with Bosniak III/IV cysts. […] The goal of this multicenter project is to conduct a prospective study with a 5-year follow-up to confirm the oncologic outcomes of active surveillance in the management of complex cysts. […] The main objectives are: 1) to compare the 5-year cancer specific survival between cysts managed by surgery and active surveillance; 2) to evaluate disease progression; 3) to evaluate patient’s well-being according to each management strategy; and 4) to compare the 5-year healthcare cost of both management approaches.
#35 Surveillance of Complex Renal Cysts – the SOCRATIC Study
https://ctv.veeva.com/study/surveillance-of-complex-renal-cysts-the-socratic-study
One third of individuals aged 60 years will be diagnosed with at least one renal cyst following abdominal imaging. […] Growing evidence suggests that a significant proportion of Bosniak III and IV cysts are benign and that the malignant ones present low metastatic potential. […] Since renal surgery carries substantial morbidity (20%) and potential mortality (0.5%), active surveillance has gained attention as a potential tradeoff to surgery to overcome overtreatment. […] Therefore, prospective studies of long-term follow-up are needed to confirm the oncologic safety of this strategy for patients with Bosniak III/IV cysts. […] The main objective is to compare the 5-year follow-up cancer-specific survival between the active surveillance and the surgical groups. […] Thus, active surveillance which involves close follow-up of a patient’s condition, was proposed as a tradeoff option to surgery.
#36 Surveillance of Complex Renal Cysts – the SOCRATIC Study
https://ctv.veeva.com/study/surveillance-of-complex-renal-cysts-the-socratic-study
One third of individuals aged 60 years will be diagnosed with at least one renal cyst following abdominal imaging. […] Growing evidence suggests that a significant proportion of Bosniak III and IV cysts are benign and that the malignant ones present low metastatic potential. […] Since renal surgery carries substantial morbidity (20%) and potential mortality (0.5%), active surveillance has gained attention as a potential tradeoff to surgery to overcome overtreatment. […] Therefore, prospective studies of long-term follow-up are needed to confirm the oncologic safety of this strategy for patients with Bosniak III/IV cysts. […] The main objective is to compare the 5-year follow-up cancer-specific survival between the active surveillance and the surgical groups. […] Thus, active surveillance which involves close follow-up of a patient’s condition, was proposed as a tradeoff option to surgery.
#37 Active surveillance of small renal masses | Insights into Imaging | Full Text
https://insightsimaging.springeropen.com/articles/10.1186/s13244-020-00853-y
Therefore, it may be possible to offer AS to patients with progressive Bosniak IIF or Bosniak III as an alternative to surgery in certain clinical scenarios similar to that of patients with SRMs. […] The size of complex renal cysts has no correlation with the incidence of RCC or tumor aggressiveness, with a recent study reporting that malignant cysts are smaller than benign cysts. […] The indolent behavior of cystic malignancies suggests that delayed intervention should be strongly considered when treating patients with cystic renal masses, even Bosniak IIIn and IV cysts in the same scenarios recommended in SRM guidelines. […] In patients with multifocal SRMs, the main objectives of management are preserving renal function, avoiding surgical morbimortality, achieving optimal oncological control, and providing long-term cancer recurrence-free survival. […] AS is the treatment of choice in sporadic multifocal and some hereditary SRMs. […] AS is effective in the treatment of SRMs.
#38 Active surveillance of small renal masses | Insights into Imaging | Full Text
https://insightsimaging.springeropen.com/articles/10.1186/s13244-020-00853-y
Therefore, it may be possible to offer AS to patients with progressive Bosniak IIF or Bosniak III as an alternative to surgery in certain clinical scenarios similar to that of patients with SRMs. […] The size of complex renal cysts has no correlation with the incidence of RCC or tumor aggressiveness, with a recent study reporting that malignant cysts are smaller than benign cysts. […] The indolent behavior of cystic malignancies suggests that delayed intervention should be strongly considered when treating patients with cystic renal masses, even Bosniak IIIn and IV cysts in the same scenarios recommended in SRM guidelines. […] In patients with multifocal SRMs, the main objectives of management are preserving renal function, avoiding surgical morbimortality, achieving optimal oncological control, and providing long-term cancer recurrence-free survival. […] AS is the treatment of choice in sporadic multifocal and some hereditary SRMs. […] AS is effective in the treatment of SRMs.
#39 Kidney | Benign Tumors & Cysts — Metrovan Urology
https://www.metrovanurology.com/kidney-benign-tumors-cysts
The Canadian Urological Association 2019 Guidline recommendations are as follows. […] Bosniak I (simple) renal cysts are common. These are almost never symptomatic regardless of size. The natural history of cysts is to grow over time and therefore growth should not necessarily be considered a sign of malignancy. Most importantly, transformation to a more complex cyst is very rare. Follow-up is not necessary or recommended. […] Bosniak II renal cysts are slightly more complex. Management is essentially the same as for Bosniak I renal cyst. […] Bosniak IIF renal cysts is an intermediate class of cysts which cannot clearly be placed into category II or III. […] Bosniak III renal cysts have an approximately 50% probability of harboring malignancy and surgical excision is generally recommended. […] Bosniak IV renal cysts have an 80-90% probability of harboring malignancy, typically cystic renal cell carcinoma. Excision is the treatment of choice though as most of low metastatic potential conservative management can be considered.
#40 Kidney | Benign Tumors & Cysts — Metrovan Urology
https://www.metrovanurology.com/kidney-benign-tumors-cysts
The Canadian Urological Association 2019 Guidline recommendations are as follows. […] Bosniak I (simple) renal cysts are common. These are almost never symptomatic regardless of size. The natural history of cysts is to grow over time and therefore growth should not necessarily be considered a sign of malignancy. Most importantly, transformation to a more complex cyst is very rare. Follow-up is not necessary or recommended. […] Bosniak II renal cysts are slightly more complex. Management is essentially the same as for Bosniak I renal cyst. […] Bosniak IIF renal cysts is an intermediate class of cysts which cannot clearly be placed into category II or III. […] Bosniak III renal cysts have an approximately 50% probability of harboring malignancy and surgical excision is generally recommended. […] Bosniak IV renal cysts have an 80-90% probability of harboring malignancy, typically cystic renal cell carcinoma. Excision is the treatment of choice though as most of low metastatic potential conservative management can be considered.
#41 Kidney | Benign Tumors & Cysts — Metrovan Urology
https://www.metrovanurology.com/kidney-benign-tumors-cysts
The Canadian Urological Association 2019 Guidline recommendations are as follows. […] Bosniak I (simple) renal cysts are common. These are almost never symptomatic regardless of size. The natural history of cysts is to grow over time and therefore growth should not necessarily be considered a sign of malignancy. Most importantly, transformation to a more complex cyst is very rare. Follow-up is not necessary or recommended. […] Bosniak II renal cysts are slightly more complex. Management is essentially the same as for Bosniak I renal cyst. […] Bosniak IIF renal cysts is an intermediate class of cysts which cannot clearly be placed into category II or III. […] Bosniak III renal cysts have an approximately 50% probability of harboring malignancy and surgical excision is generally recommended. […] Bosniak IV renal cysts have an 80-90% probability of harboring malignancy, typically cystic renal cell carcinoma. Excision is the treatment of choice though as most of low metastatic potential conservative management can be considered.
#42 Surveillance and clinical outcome of bosniak IIF renal cysts: a mini review – MedCrave online
https://medcraveonline.com/UNOAJ/surveillance-and-clinical-outcome-of-bosniak-iif-renal-cysts-a-mini-review.html
Based on studies that investigated the diagnosis, pathology and findings of Bosniak Type IIF and III cystic lesions, it was confirmed that approximately 30% of Bosniak IIF cysts are at risk of malignancy; consequently, prolonged monitoring for close to 5 years should be the standard form of treatment. […] Progressive Bosniak IIF lesions may be excised surgically. […] Imaging procedures on Bosniak IIF lesions fluctuates, depending largely on urologists and radiologists’ comprehension. […] The aim of imaging surveillance is to detect Bosniak IIF renal cysts that progress to higher class lesions, because higher reclassification is linked to higher class lesions. […] Frequent follow-up is inadequate among young patients. […] Nevertheless, intensive surveillance is the best way for monitoring the progress of Bosniak Class IIF cases.
#43 Surveillance and clinical outcome of bosniak IIF renal cysts: a mini review – MedCrave online
https://medcraveonline.com/UNOAJ/surveillance-and-clinical-outcome-of-bosniak-iif-renal-cysts-a-mini-review.html
Based on studies that investigated the diagnosis, pathology and findings of Bosniak Type IIF and III cystic lesions, it was confirmed that approximately 30% of Bosniak IIF cysts are at risk of malignancy; consequently, prolonged monitoring for close to 5 years should be the standard form of treatment. […] Progressive Bosniak IIF lesions may be excised surgically. […] Imaging procedures on Bosniak IIF lesions fluctuates, depending largely on urologists and radiologists’ comprehension. […] The aim of imaging surveillance is to detect Bosniak IIF renal cysts that progress to higher class lesions, because higher reclassification is linked to higher class lesions. […] Frequent follow-up is inadequate among young patients. […] Nevertheless, intensive surveillance is the best way for monitoring the progress of Bosniak Class IIF cases.
#44 Kidney | Benign Tumors & Cysts — Metrovan Urology
https://www.metrovanurology.com/kidney-benign-tumors-cysts
The Canadian Urological Association 2019 Guidline recommendations are as follows. […] Bosniak I (simple) renal cysts are common. These are almost never symptomatic regardless of size. The natural history of cysts is to grow over time and therefore growth should not necessarily be considered a sign of malignancy. Most importantly, transformation to a more complex cyst is very rare. Follow-up is not necessary or recommended. […] Bosniak II renal cysts are slightly more complex. Management is essentially the same as for Bosniak I renal cyst. […] Bosniak IIF renal cysts is an intermediate class of cysts which cannot clearly be placed into category II or III. […] Bosniak III renal cysts have an approximately 50% probability of harboring malignancy and surgical excision is generally recommended. […] Bosniak IV renal cysts have an 80-90% probability of harboring malignancy, typically cystic renal cell carcinoma. Excision is the treatment of choice though as most of low metastatic potential conservative management can be considered.
#45 Active surveillance versus initial surgery in the long-term management of Bosniak IIFâIV cystic renal masses | Scientific Reports
https://www.nature.com/articles/s41598-022-14056-6
There may be surgical overtreatment of complex cystic renal masses (CRM). Growing evidence supports active surveillance (AS) for the management for Bosniak IIFIII CRMs. […] AS did not increase the risk of metastatic spread or cancer-specific mortality in patients with Bosniak IIFIV. Our data indicate AS in Bosniak IIF and III is safe. Surgery is the primary treatment for Bosniak IV due to its high malignancy rate. […] The risk of RCC varies between Bosniak categories. According to a meta-analysis by Schoots et al., RCC incidence was 618% for Bosniak IIF, 5155% for Bosniak III and 8991% for Bosniak IV CRMs. […] The current treatment recommendations are based on retrospective studies with small cohorts and short follow-up. […] The aim of the study was to evaluate the management, pathological and oncological outcomes of patients with Bosniak IIFIV CRMs in a large single center series.
#46 Active surveillance versus initial surgery in the long-term management of Bosniak IIFâIV cystic renal masses | Scientific Reports
https://www.nature.com/articles/s41598-022-14056-6
In conclusion, metastatic progression in Bosniak IIFIV CRMs is uncommon. AS does not increase the risk of metastatic spread or cancer-specific mortality of patients with Bosniak IIF III CRMs. Our results support the safety of AS in Bosniak IIF III CRMs and confirms surgery as the primary initial treatment for patients with Bosniak IV due to its associated high malignancy rate.
#47 Kidney | Benign Tumors & Cysts — Metrovan Urology
https://www.metrovanurology.com/kidney-benign-tumors-cysts
The Canadian Urological Association 2019 Guidline recommendations are as follows. […] Bosniak I (simple) renal cysts are common. These are almost never symptomatic regardless of size. The natural history of cysts is to grow over time and therefore growth should not necessarily be considered a sign of malignancy. Most importantly, transformation to a more complex cyst is very rare. Follow-up is not necessary or recommended. […] Bosniak II renal cysts are slightly more complex. Management is essentially the same as for Bosniak I renal cyst. […] Bosniak IIF renal cysts is an intermediate class of cysts which cannot clearly be placed into category II or III. […] Bosniak III renal cysts have an approximately 50% probability of harboring malignancy and surgical excision is generally recommended. […] Bosniak IV renal cysts have an 80-90% probability of harboring malignancy, typically cystic renal cell carcinoma. Excision is the treatment of choice though as most of low metastatic potential conservative management can be considered.
#48 Active surveillance versus initial surgery in the long-term management of Bosniak IIFâIV cystic renal masses | Scientific Reports
https://www.nature.com/articles/s41598-022-14056-6
There may be surgical overtreatment of complex cystic renal masses (CRM). Growing evidence supports active surveillance (AS) for the management for Bosniak IIFIII CRMs. […] AS did not increase the risk of metastatic spread or cancer-specific mortality in patients with Bosniak IIFIV. Our data indicate AS in Bosniak IIF and III is safe. Surgery is the primary treatment for Bosniak IV due to its high malignancy rate. […] The risk of RCC varies between Bosniak categories. According to a meta-analysis by Schoots et al., RCC incidence was 618% for Bosniak IIF, 5155% for Bosniak III and 8991% for Bosniak IV CRMs. […] The current treatment recommendations are based on retrospective studies with small cohorts and short follow-up. […] The aim of the study was to evaluate the management, pathological and oncological outcomes of patients with Bosniak IIFIV CRMs in a large single center series.
#49 Active surveillance versus initial surgery in the long-term management of Bosniak IIFâIV cystic renal masses | Scientific Reports
https://www.nature.com/articles/s41598-022-14056-6
In conclusion, metastatic progression in Bosniak IIFIV CRMs is uncommon. AS does not increase the risk of metastatic spread or cancer-specific mortality of patients with Bosniak IIF III CRMs. Our results support the safety of AS in Bosniak IIF III CRMs and confirms surgery as the primary initial treatment for patients with Bosniak IV due to its associated high malignancy rate.
#50 Acquired cystic kidney disease | Radiology Reference Article | Radiopaedia.org
https://radiopaedia.org/articles/acquired-cystic-kidney-disease-1?lang=us
Its incidence increases with the amount of time a patient is azotemic and has been estimated at 44% after three years of dialysis and 90% after ten years of dialysis. […] It is equally common with hemodialysis as with peritoneal dialysis. […] imaging screening for these patients is controversial. […] one screening strategy images patients 55 years old who have been on dialysis for three years.
#51 Acquired cystic kidney disease | Radiology Reference Article | Radiopaedia.org
https://radiopaedia.org/articles/acquired-cystic-kidney-disease-1?lang=us
Its incidence increases with the amount of time a patient is azotemic and has been estimated at 44% after three years of dialysis and 90% after ten years of dialysis. […] It is equally common with hemodialysis as with peritoneal dialysis. […] imaging screening for these patients is controversial. […] one screening strategy images patients 55 years old who have been on dialysis for three years.
#52 Active surveillance for complex renal cysts: is it time for III-F and IV-F? – Nolazco – AME Medical Journal
https://amj.amegroups.org/article/view/7426/html
Renal cysts are highly common and estimated to be present in at least one-third of all individuals over the age of 60 (1). […] The incidence of kidney cancer has doubled in the US; however, mortality rates remain the same, suggesting overdiagnosis of clinically insignificant kidney cancers (6). […] Recent guideline updates from various medical organizations suggest a shift in management in renal cysts towards more conservative management (Table 1). […] The improving clinical management of SRM and improved understanding of the natural history of renal cysts have increased the confidence in a more conservative approach characterized by AS in the management of Bosniak III and IV. Proper patient select, weighing the potential oncological benefit and the competing risks of death, is the key to ensuring adequate treatment for Bosniak III and IV renal cysts. […] Guidelines adopted AS as an alternative for managing renal complex cysts Bosniak III and IV.
#53 Active surveillance for complex renal cysts: is it time for III-F and IV-F? – Nolazco – AME Medical Journal
https://amj.amegroups.org/article/view/7426/html
Renal cysts are highly common and estimated to be present in at least one-third of all individuals over the age of 60 (1). […] The incidence of kidney cancer has doubled in the US; however, mortality rates remain the same, suggesting overdiagnosis of clinically insignificant kidney cancers (6). […] Recent guideline updates from various medical organizations suggest a shift in management in renal cysts towards more conservative management (Table 1). […] The improving clinical management of SRM and improved understanding of the natural history of renal cysts have increased the confidence in a more conservative approach characterized by AS in the management of Bosniak III and IV. Proper patient select, weighing the potential oncological benefit and the competing risks of death, is the key to ensuring adequate treatment for Bosniak III and IV renal cysts. […] Guidelines adopted AS as an alternative for managing renal complex cysts Bosniak III and IV.
#54 Cystic Renal Masses Often Harbor High-Grade Disease | MedPage Today
https://www.medpagetoday.com/nephrology/generalnephrology/105056
Pathologically confirmed cRCC has a recurrence-free survival approaching 100%, and cystic masses have better outcomes with AS as compared with solid masses. […] Evaluation of 184 patients on AS showed that Bosniak IV lesions had faster growth rates as compared with Bosniak IIF and III lesions. […] However, growth rate was not associated with presence of high-grade pathology. […] Cancer-specific survival was similar for patients who had surgery or ablation (99%) versus those on AS (100%). […] The findings revealed a disconnect between cystic designation on imaging and pathologic findings. […] Despite the relatively high rate of high-grade disease in resected cystic lesions, AS with or without delayed intervention appears safe and effective for most radiographically cystic renal masses.
#55 Cystic Renal Masses Often Harbor High-Grade Disease | MedPage Today
https://www.medpagetoday.com/nephrology/generalnephrology/105056
Almost a fourth of renal cysts had pathologically high-grade disease, which did not have a correlation with growth rate or increase the risk with active surveillance (AS), according to a large retrospective review. […] Overall, 23% of 387 radiographically confirmed cystic lesions exhibited high-grade pathology. […] Nonetheless, the potentially more aggressive subset did not affect overall survival, which was similar between patients who had immediate surgery and those who opted for AS. […] The findings challenge historical assumptions about the nature of the biologically heterogeneous cystic lesions, reported Randall A. Lee, MD, of Fox Chase Cancer Center in Philadelphia, and colleagues in the Journal of Urology. […] In particular, cystic masses are candidates for appropriate de-escalation of care, they continued. Cystic renal cell carcinoma (cRCC) encompasses a spectrum of lesions containing benign and malignant histologies.
#56 Cystic Renal Masses Often Harbor High-Grade Disease | MedPage Today
https://www.medpagetoday.com/nephrology/generalnephrology/105056
Almost a fourth of renal cysts had pathologically high-grade disease, which did not have a correlation with growth rate or increase the risk with active surveillance (AS), according to a large retrospective review. […] Overall, 23% of 387 radiographically confirmed cystic lesions exhibited high-grade pathology. […] Nonetheless, the potentially more aggressive subset did not affect overall survival, which was similar between patients who had immediate surgery and those who opted for AS. […] The findings challenge historical assumptions about the nature of the biologically heterogeneous cystic lesions, reported Randall A. Lee, MD, of Fox Chase Cancer Center in Philadelphia, and colleagues in the Journal of Urology. […] In particular, cystic masses are candidates for appropriate de-escalation of care, they continued. Cystic renal cell carcinoma (cRCC) encompasses a spectrum of lesions containing benign and malignant histologies.
#57 Cystic Renal Masses Often Harbor High-Grade Disease | MedPage Today
https://www.medpagetoday.com/nephrology/generalnephrology/105056
Almost a fourth of renal cysts had pathologically high-grade disease, which did not have a correlation with growth rate or increase the risk with active surveillance (AS), according to a large retrospective review. […] Overall, 23% of 387 radiographically confirmed cystic lesions exhibited high-grade pathology. […] Nonetheless, the potentially more aggressive subset did not affect overall survival, which was similar between patients who had immediate surgery and those who opted for AS. […] The findings challenge historical assumptions about the nature of the biologically heterogeneous cystic lesions, reported Randall A. Lee, MD, of Fox Chase Cancer Center in Philadelphia, and colleagues in the Journal of Urology. […] In particular, cystic masses are candidates for appropriate de-escalation of care, they continued. Cystic renal cell carcinoma (cRCC) encompasses a spectrum of lesions containing benign and malignant histologies.
#58 Cystic Renal Masses Often Harbor High-Grade Disease | MedPage Today
https://www.medpagetoday.com/nephrology/generalnephrology/105056
Almost a fourth of renal cysts had pathologically high-grade disease, which did not have a correlation with growth rate or increase the risk with active surveillance (AS), according to a large retrospective review. […] Overall, 23% of 387 radiographically confirmed cystic lesions exhibited high-grade pathology. […] Nonetheless, the potentially more aggressive subset did not affect overall survival, which was similar between patients who had immediate surgery and those who opted for AS. […] The findings challenge historical assumptions about the nature of the biologically heterogeneous cystic lesions, reported Randall A. Lee, MD, of Fox Chase Cancer Center in Philadelphia, and colleagues in the Journal of Urology. […] In particular, cystic masses are candidates for appropriate de-escalation of care, they continued. Cystic renal cell carcinoma (cRCC) encompasses a spectrum of lesions containing benign and malignant histologies.
#59 Cystic Renal Masses Often Harbor High-Grade Disease | MedPage Today
https://www.medpagetoday.com/nephrology/generalnephrology/105056
Pathologically confirmed cRCC has a recurrence-free survival approaching 100%, and cystic masses have better outcomes with AS as compared with solid masses. […] Evaluation of 184 patients on AS showed that Bosniak IV lesions had faster growth rates as compared with Bosniak IIF and III lesions. […] However, growth rate was not associated with presence of high-grade pathology. […] Cancer-specific survival was similar for patients who had surgery or ablation (99%) versus those on AS (100%). […] The findings revealed a disconnect between cystic designation on imaging and pathologic findings. […] Despite the relatively high rate of high-grade disease in resected cystic lesions, AS with or without delayed intervention appears safe and effective for most radiographically cystic renal masses.
#60 Active surveillance versus initial surgery in the long-term management of Bosniak IIFâIV cystic renal masses | Scientific Reports
https://www.nature.com/articles/s41598-022-14056-6
There may be surgical overtreatment of complex cystic renal masses (CRM). Growing evidence supports active surveillance (AS) for the management for Bosniak IIFIII CRMs. […] AS did not increase the risk of metastatic spread or cancer-specific mortality in patients with Bosniak IIFIV. Our data indicate AS in Bosniak IIF and III is safe. Surgery is the primary treatment for Bosniak IV due to its high malignancy rate. […] The risk of RCC varies between Bosniak categories. According to a meta-analysis by Schoots et al., RCC incidence was 618% for Bosniak IIF, 5155% for Bosniak III and 8991% for Bosniak IV CRMs. […] The current treatment recommendations are based on retrospective studies with small cohorts and short follow-up. […] The aim of the study was to evaluate the management, pathological and oncological outcomes of patients with Bosniak IIFIV CRMs in a large single center series.
#61 Active surveillance versus initial surgery in the long-term management of Bosniak IIFâIV cystic renal masses | Scientific Reports
https://www.nature.com/articles/s41598-022-14056-6
In conclusion, metastatic progression in Bosniak IIFIV CRMs is uncommon. AS does not increase the risk of metastatic spread or cancer-specific mortality of patients with Bosniak IIF III CRMs. Our results support the safety of AS in Bosniak IIF III CRMs and confirms surgery as the primary initial treatment for patients with Bosniak IV due to its associated high malignancy rate.
#62 Cystic Renal Masses Often Harbor High-Grade Disease | MedPage Today
https://www.medpagetoday.com/nephrology/generalnephrology/105056
Pathologically confirmed cRCC has a recurrence-free survival approaching 100%, and cystic masses have better outcomes with AS as compared with solid masses. […] Evaluation of 184 patients on AS showed that Bosniak IV lesions had faster growth rates as compared with Bosniak IIF and III lesions. […] However, growth rate was not associated with presence of high-grade pathology. […] Cancer-specific survival was similar for patients who had surgery or ablation (99%) versus those on AS (100%). […] The findings revealed a disconnect between cystic designation on imaging and pathologic findings. […] Despite the relatively high rate of high-grade disease in resected cystic lesions, AS with or without delayed intervention appears safe and effective for most radiographically cystic renal masses.
#63 Active surveillance versus initial surgery in the long-term management of Bosniak IIFâIV cystic renal masses | Scientific Reports
https://www.nature.com/articles/s41598-022-14056-6
There may be surgical overtreatment of complex cystic renal masses (CRM). Growing evidence supports active surveillance (AS) for the management for Bosniak IIFIII CRMs. […] AS did not increase the risk of metastatic spread or cancer-specific mortality in patients with Bosniak IIFIV. Our data indicate AS in Bosniak IIF and III is safe. Surgery is the primary treatment for Bosniak IV due to its high malignancy rate. […] The risk of RCC varies between Bosniak categories. According to a meta-analysis by Schoots et al., RCC incidence was 618% for Bosniak IIF, 5155% for Bosniak III and 8991% for Bosniak IV CRMs. […] The current treatment recommendations are based on retrospective studies with small cohorts and short follow-up. […] The aim of the study was to evaluate the management, pathological and oncological outcomes of patients with Bosniak IIFIV CRMs in a large single center series.
#64 Cystic Renal Masses Often Harbor High-Grade Disease | MedPage Today
https://www.medpagetoday.com/nephrology/generalnephrology/105056
Pathologically confirmed cRCC has a recurrence-free survival approaching 100%, and cystic masses have better outcomes with AS as compared with solid masses. […] Evaluation of 184 patients on AS showed that Bosniak IV lesions had faster growth rates as compared with Bosniak IIF and III lesions. […] However, growth rate was not associated with presence of high-grade pathology. […] Cancer-specific survival was similar for patients who had surgery or ablation (99%) versus those on AS (100%). […] The findings revealed a disconnect between cystic designation on imaging and pathologic findings. […] Despite the relatively high rate of high-grade disease in resected cystic lesions, AS with or without delayed intervention appears safe and effective for most radiographically cystic renal masses.
#65 Active surveillance versus initial surgery in the long-term management of Bosniak IIFâIV cystic renal masses | Scientific Reports
https://www.nature.com/articles/s41598-022-14056-6
In conclusion, metastatic progression in Bosniak IIFIV CRMs is uncommon. AS does not increase the risk of metastatic spread or cancer-specific mortality of patients with Bosniak IIF III CRMs. Our results support the safety of AS in Bosniak IIF III CRMs and confirms surgery as the primary initial treatment for patients with Bosniak IV due to its associated high malignancy rate.
#66 Management of complex renal cysts in Canada: results of a survey study | BMC Urology | Full Text
https://bmcurol.biomedcentral.com/articles/10.1186/s12894-020-00614-5
Despite active surveillance being included as a management option in guidelines, many Canadian urologists are reluctant to offer surveillance to patients with Bosniak III or IV cysts. Practice patterns are heterogeneous among those offering surveillance. High-quality studies are required to better define the benefits and risks of cystic renal mass surveillance. […] Recent observational data has provided support for the use of active surveillance among patients with complex renal cysts. However, the adoption of this treatment strategy for the management of complex cysts in Canada and the criteria used by urologists as triggers for discontinuation of surveillance and intervention have yet to be defined. […] The objectives of this survey study were to characterize the use of active surveillance in the management of complex renal cysts in Canada and to elicit the perceived barriers to adoption.
#67 Management of complex renal cysts in Canada: results of a survey study | BMC Urology | Full Text
https://bmcurol.biomedcentral.com/articles/10.1186/s12894-020-00614-5
Several potential barriers to a greater adoption of active surveillance were noted. The most commonly reported ones were [1] the patients and physicians concerns regarding the oncologic safety and/or benefits of active surveillance (89.8%), [2] the lack of data supporting active surveillance in patients with Bosniak III-IV cysts (74.2%), and [3] the lack of specific triggers for intervention during surveillance for complex renal cysts (75.8%). […] This study supports that, despite the lack of high-quality evidence, many Canadian urologists offer active surveillance as an option to patients with complex renal cysts, especially if they have a Bosniak III cyst. However, the lack of sufficient data or guidelines on safety seems to prevent widespread adoption of active surveillance. Prospective studies should be conducted to provide evidence on the oncologic safety, benefits, harms, cost, eligibility criteria, and guidelines for the discontinuation of active surveillance in the management of Bosniak III and IV cysts.
#68 Management of complex renal cysts in Canada: results of a survey study | BMC Urology | Full Text
https://bmcurol.biomedcentral.com/articles/10.1186/s12894-020-00614-5
Several potential barriers to a greater adoption of active surveillance were noted. The most commonly reported ones were [1] the patients and physicians concerns regarding the oncologic safety and/or benefits of active surveillance (89.8%), [2] the lack of data supporting active surveillance in patients with Bosniak III-IV cysts (74.2%), and [3] the lack of specific triggers for intervention during surveillance for complex renal cysts (75.8%). […] This study supports that, despite the lack of high-quality evidence, many Canadian urologists offer active surveillance as an option to patients with complex renal cysts, especially if they have a Bosniak III cyst. However, the lack of sufficient data or guidelines on safety seems to prevent widespread adoption of active surveillance. Prospective studies should be conducted to provide evidence on the oncologic safety, benefits, harms, cost, eligibility criteria, and guidelines for the discontinuation of active surveillance in the management of Bosniak III and IV cysts.
#69 Management of complex renal cysts in Canada: results of a survey study | BMC Urology | Full Text
https://bmcurol.biomedcentral.com/articles/10.1186/s12894-020-00614-5
Several potential barriers to a greater adoption of active surveillance were noted. The most commonly reported ones were [1] the patients and physicians concerns regarding the oncologic safety and/or benefits of active surveillance (89.8%), [2] the lack of data supporting active surveillance in patients with Bosniak III-IV cysts (74.2%), and [3] the lack of specific triggers for intervention during surveillance for complex renal cysts (75.8%). […] This study supports that, despite the lack of high-quality evidence, many Canadian urologists offer active surveillance as an option to patients with complex renal cysts, especially if they have a Bosniak III cyst. However, the lack of sufficient data or guidelines on safety seems to prevent widespread adoption of active surveillance. Prospective studies should be conducted to provide evidence on the oncologic safety, benefits, harms, cost, eligibility criteria, and guidelines for the discontinuation of active surveillance in the management of Bosniak III and IV cysts.
#70 Management of complex renal cysts in Canada: results of a survey study | BMC Urology | Full Text
https://bmcurol.biomedcentral.com/articles/10.1186/s12894-020-00614-5
Several potential barriers to a greater adoption of active surveillance were noted. The most commonly reported ones were [1] the patients and physicians concerns regarding the oncologic safety and/or benefits of active surveillance (89.8%), [2] the lack of data supporting active surveillance in patients with Bosniak III-IV cysts (74.2%), and [3] the lack of specific triggers for intervention during surveillance for complex renal cysts (75.8%). […] This study supports that, despite the lack of high-quality evidence, many Canadian urologists offer active surveillance as an option to patients with complex renal cysts, especially if they have a Bosniak III cyst. However, the lack of sufficient data or guidelines on safety seems to prevent widespread adoption of active surveillance. Prospective studies should be conducted to provide evidence on the oncologic safety, benefits, harms, cost, eligibility criteria, and guidelines for the discontinuation of active surveillance in the management of Bosniak III and IV cysts.
#71 Management of complex renal cysts in Canada: results of a survey study | BMC Urology | Full Text
https://bmcurol.biomedcentral.com/articles/10.1186/s12894-020-00614-5
Several potential barriers to a greater adoption of active surveillance were noted. The most commonly reported ones were [1] the patients and physicians concerns regarding the oncologic safety and/or benefits of active surveillance (89.8%), [2] the lack of data supporting active surveillance in patients with Bosniak III-IV cysts (74.2%), and [3] the lack of specific triggers for intervention during surveillance for complex renal cysts (75.8%). […] This study supports that, despite the lack of high-quality evidence, many Canadian urologists offer active surveillance as an option to patients with complex renal cysts, especially if they have a Bosniak III cyst. However, the lack of sufficient data or guidelines on safety seems to prevent widespread adoption of active surveillance. Prospective studies should be conducted to provide evidence on the oncologic safety, benefits, harms, cost, eligibility criteria, and guidelines for the discontinuation of active surveillance in the management of Bosniak III and IV cysts.
#72 Surveillance of Complex Renal Cysts – the SOCRATIC Study
https://ctv.veeva.com/study/surveillance-of-complex-renal-cysts-the-socratic-study
One third of individuals aged 60 years will be diagnosed with at least one renal cyst following abdominal imaging. […] Growing evidence suggests that a significant proportion of Bosniak III and IV cysts are benign and that the malignant ones present low metastatic potential. […] Since renal surgery carries substantial morbidity (20%) and potential mortality (0.5%), active surveillance has gained attention as a potential tradeoff to surgery to overcome overtreatment. […] Therefore, prospective studies of long-term follow-up are needed to confirm the oncologic safety of this strategy for patients with Bosniak III/IV cysts. […] The main objective is to compare the 5-year follow-up cancer-specific survival between the active surveillance and the surgical groups. […] Thus, active surveillance which involves close follow-up of a patient’s condition, was proposed as a tradeoff option to surgery.
#73 Surveillance of Complex Renal Cysts – the SOCRATIC Study | Clinical Research Trial Listing
https://www.centerwatch.com/clinical-trials/listings/NCT04558593/surveillance-of-complex-renal-cysts-the-socratic-study
One third of individuals aged 60 years will be diagnosed with at least one renal cyst following abdominal imaging. […] Growing evidence suggests that a significant proportion of Bosniak III and IV cysts are benign and that the malignant ones present low metastatic potential. […] Therefore, prospective studies of long-term follow-up are needed to confirm the oncologic safety of this strategy for patients with Bosniak III/IV cysts. […] The goal of this multicenter project is to conduct a prospective study with a 5-year follow-up to confirm the oncologic outcomes of active surveillance in the management of complex cysts. […] The main objectives are: 1) to compare the 5-year cancer specific survival between cysts managed by surgery and active surveillance; 2) to evaluate disease progression; 3) to evaluate patient’s well-being according to each management strategy; and 4) to compare the 5-year healthcare cost of both management approaches.
#74 Surveillance of Complex Renal Cysts – the SOCRATIC Study
https://ctv.veeva.com/study/surveillance-of-complex-renal-cysts-the-socratic-study
The goal of this multicenter project is to conduct a prospective study with a 5-year follow-up to confirm the oncologic outcomes of active surveillance in the management of complex cysts. […] The main objectives are: 1) to compare the 5-year cancer specific survival between cysts managed by surgery and active surveillance; 2) to evaluate disease progression; 3) to evaluate patient’s well-being according to each management strategy; and 4) to compare the 5-year healthcare cost of both management approaches. […] Patients on active surveillance will also be assessed for cyst progression and might be offered invasive or systemic therapy if progression is observed.
#75 Surveillance of Complex Renal Cysts – the SOCRATIC Study | Clinical Research Trial Listing
https://www.centerwatch.com/clinical-trials/listings/NCT04558593/surveillance-of-complex-renal-cysts-the-socratic-study
One third of individuals aged 60 years will be diagnosed with at least one renal cyst following abdominal imaging. […] Growing evidence suggests that a significant proportion of Bosniak III and IV cysts are benign and that the malignant ones present low metastatic potential. […] Therefore, prospective studies of long-term follow-up are needed to confirm the oncologic safety of this strategy for patients with Bosniak III/IV cysts. […] The goal of this multicenter project is to conduct a prospective study with a 5-year follow-up to confirm the oncologic outcomes of active surveillance in the management of complex cysts. […] The main objectives are: 1) to compare the 5-year cancer specific survival between cysts managed by surgery and active surveillance; 2) to evaluate disease progression; 3) to evaluate patient’s well-being according to each management strategy; and 4) to compare the 5-year healthcare cost of both management approaches.
#76 Surveillance of Complex Renal Cysts – the SOCRATIC Study
https://ctv.veeva.com/study/surveillance-of-complex-renal-cysts-the-socratic-study
The goal of this multicenter project is to conduct a prospective study with a 5-year follow-up to confirm the oncologic outcomes of active surveillance in the management of complex cysts. […] The main objectives are: 1) to compare the 5-year cancer specific survival between cysts managed by surgery and active surveillance; 2) to evaluate disease progression; 3) to evaluate patient’s well-being according to each management strategy; and 4) to compare the 5-year healthcare cost of both management approaches. […] Patients on active surveillance will also be assessed for cyst progression and might be offered invasive or systemic therapy if progression is observed.
#77 Surveillance of Complex Renal Cysts – the SOCRATIC Study | Clinical Research Trial Listing
https://www.centerwatch.com/clinical-trials/listings/NCT04558593/surveillance-of-complex-renal-cysts-the-socratic-study
One third of individuals aged 60 years will be diagnosed with at least one renal cyst following abdominal imaging. […] Growing evidence suggests that a significant proportion of Bosniak III and IV cysts are benign and that the malignant ones present low metastatic potential. […] Therefore, prospective studies of long-term follow-up are needed to confirm the oncologic safety of this strategy for patients with Bosniak III/IV cysts. […] The goal of this multicenter project is to conduct a prospective study with a 5-year follow-up to confirm the oncologic outcomes of active surveillance in the management of complex cysts. […] The main objectives are: 1) to compare the 5-year cancer specific survival between cysts managed by surgery and active surveillance; 2) to evaluate disease progression; 3) to evaluate patient’s well-being according to each management strategy; and 4) to compare the 5-year healthcare cost of both management approaches.
#78 Surveillance of Complex Renal Cysts – the SOCRATIC Study
https://ctv.veeva.com/study/surveillance-of-complex-renal-cysts-the-socratic-study
The goal of this multicenter project is to conduct a prospective study with a 5-year follow-up to confirm the oncologic outcomes of active surveillance in the management of complex cysts. […] The main objectives are: 1) to compare the 5-year cancer specific survival between cysts managed by surgery and active surveillance; 2) to evaluate disease progression; 3) to evaluate patient’s well-being according to each management strategy; and 4) to compare the 5-year healthcare cost of both management approaches. […] Patients on active surveillance will also be assessed for cyst progression and might be offered invasive or systemic therapy if progression is observed.
#79 Surveillance of Complex Renal Cysts – the SOCRATIC Study | Clinical Research Trial Listing
https://www.centerwatch.com/clinical-trials/listings/NCT04558593/surveillance-of-complex-renal-cysts-the-socratic-study
One third of individuals aged 60 years will be diagnosed with at least one renal cyst following abdominal imaging. […] Growing evidence suggests that a significant proportion of Bosniak III and IV cysts are benign and that the malignant ones present low metastatic potential. […] Therefore, prospective studies of long-term follow-up are needed to confirm the oncologic safety of this strategy for patients with Bosniak III/IV cysts. […] The goal of this multicenter project is to conduct a prospective study with a 5-year follow-up to confirm the oncologic outcomes of active surveillance in the management of complex cysts. […] The main objectives are: 1) to compare the 5-year cancer specific survival between cysts managed by surgery and active surveillance; 2) to evaluate disease progression; 3) to evaluate patient’s well-being according to each management strategy; and 4) to compare the 5-year healthcare cost of both management approaches.
#80 Surveillance of Complex Renal Cysts – the SOCRATIC Study
https://ctv.veeva.com/study/surveillance-of-complex-renal-cysts-the-socratic-study
The goal of this multicenter project is to conduct a prospective study with a 5-year follow-up to confirm the oncologic outcomes of active surveillance in the management of complex cysts. […] The main objectives are: 1) to compare the 5-year cancer specific survival between cysts managed by surgery and active surveillance; 2) to evaluate disease progression; 3) to evaluate patient’s well-being according to each management strategy; and 4) to compare the 5-year healthcare cost of both management approaches. […] Patients on active surveillance will also be assessed for cyst progression and might be offered invasive or systemic therapy if progression is observed.
#81 Surveillance of Complex Renal Cysts – the SOCRATIC Study | Clinical Research Trial Listing
https://www.centerwatch.com/clinical-trials/listings/NCT04558593/surveillance-of-complex-renal-cysts-the-socratic-study
One third of individuals aged 60 years will be diagnosed with at least one renal cyst following abdominal imaging. […] Growing evidence suggests that a significant proportion of Bosniak III and IV cysts are benign and that the malignant ones present low metastatic potential. […] Therefore, prospective studies of long-term follow-up are needed to confirm the oncologic safety of this strategy for patients with Bosniak III/IV cysts. […] The goal of this multicenter project is to conduct a prospective study with a 5-year follow-up to confirm the oncologic outcomes of active surveillance in the management of complex cysts. […] The main objectives are: 1) to compare the 5-year cancer specific survival between cysts managed by surgery and active surveillance; 2) to evaluate disease progression; 3) to evaluate patient’s well-being according to each management strategy; and 4) to compare the 5-year healthcare cost of both management approaches.
#82 Surveillance of Complex Renal Cysts – the SOCRATIC Study
https://ctv.veeva.com/study/surveillance-of-complex-renal-cysts-the-socratic-study
The goal of this multicenter project is to conduct a prospective study with a 5-year follow-up to confirm the oncologic outcomes of active surveillance in the management of complex cysts. […] The main objectives are: 1) to compare the 5-year cancer specific survival between cysts managed by surgery and active surveillance; 2) to evaluate disease progression; 3) to evaluate patient’s well-being according to each management strategy; and 4) to compare the 5-year healthcare cost of both management approaches. […] Patients on active surveillance will also be assessed for cyst progression and might be offered invasive or systemic therapy if progression is observed.
#83 Surveillance of Complex Renal Cysts – the SOCRATIC Study | Clinical Research Trial Listing
https://www.centerwatch.com/clinical-trials/listings/NCT04558593/surveillance-of-complex-renal-cysts-the-socratic-study
One third of individuals aged 60 years will be diagnosed with at least one renal cyst following abdominal imaging. […] Growing evidence suggests that a significant proportion of Bosniak III and IV cysts are benign and that the malignant ones present low metastatic potential. […] Therefore, prospective studies of long-term follow-up are needed to confirm the oncologic safety of this strategy for patients with Bosniak III/IV cysts. […] The goal of this multicenter project is to conduct a prospective study with a 5-year follow-up to confirm the oncologic outcomes of active surveillance in the management of complex cysts. […] The main objectives are: 1) to compare the 5-year cancer specific survival between cysts managed by surgery and active surveillance; 2) to evaluate disease progression; 3) to evaluate patient’s well-being according to each management strategy; and 4) to compare the 5-year healthcare cost of both management approaches.
#84 Surveillance of Complex Renal Cysts – the SOCRATIC Study
https://ctv.veeva.com/study/surveillance-of-complex-renal-cysts-the-socratic-study
The goal of this multicenter project is to conduct a prospective study with a 5-year follow-up to confirm the oncologic outcomes of active surveillance in the management of complex cysts. […] The main objectives are: 1) to compare the 5-year cancer specific survival between cysts managed by surgery and active surveillance; 2) to evaluate disease progression; 3) to evaluate patient’s well-being according to each management strategy; and 4) to compare the 5-year healthcare cost of both management approaches. […] Patients on active surveillance will also be assessed for cyst progression and might be offered invasive or systemic therapy if progression is observed.
#85 Active surveillance for complex renal cysts: is it time for III-F and IV-F? – Nolazco – AME Medical Journal
https://amj.amegroups.org/article/view/7426/html
Renal cysts are highly common and estimated to be present in at least one-third of all individuals over the age of 60 (1). […] The incidence of kidney cancer has doubled in the US; however, mortality rates remain the same, suggesting overdiagnosis of clinically insignificant kidney cancers (6). […] Recent guideline updates from various medical organizations suggest a shift in management in renal cysts towards more conservative management (Table 1). […] The improving clinical management of SRM and improved understanding of the natural history of renal cysts have increased the confidence in a more conservative approach characterized by AS in the management of Bosniak III and IV. Proper patient select, weighing the potential oncological benefit and the competing risks of death, is the key to ensuring adequate treatment for Bosniak III and IV renal cysts. […] Guidelines adopted AS as an alternative for managing renal complex cysts Bosniak III and IV.
#86 Active surveillance for complex renal cysts: is it time for III-F and IV-F? – Nolazco – AME Medical Journal
https://amj.amegroups.org/article/view/7426/html
Renal cysts are highly common and estimated to be present in at least one-third of all individuals over the age of 60 (1). […] The incidence of kidney cancer has doubled in the US; however, mortality rates remain the same, suggesting overdiagnosis of clinically insignificant kidney cancers (6). […] Recent guideline updates from various medical organizations suggest a shift in management in renal cysts towards more conservative management (Table 1). […] The improving clinical management of SRM and improved understanding of the natural history of renal cysts have increased the confidence in a more conservative approach characterized by AS in the management of Bosniak III and IV. Proper patient select, weighing the potential oncological benefit and the competing risks of death, is the key to ensuring adequate treatment for Bosniak III and IV renal cysts. […] Guidelines adopted AS as an alternative for managing renal complex cysts Bosniak III and IV.
#87 Active surveillance for complex renal cysts: is it time for III-F and IV-F? – Nolazco – AME Medical Journal
https://amj.amegroups.org/article/view/7426/html
Renal cysts are highly common and estimated to be present in at least one-third of all individuals over the age of 60 (1). […] The incidence of kidney cancer has doubled in the US; however, mortality rates remain the same, suggesting overdiagnosis of clinically insignificant kidney cancers (6). […] Recent guideline updates from various medical organizations suggest a shift in management in renal cysts towards more conservative management (Table 1). […] The improving clinical management of SRM and improved understanding of the natural history of renal cysts have increased the confidence in a more conservative approach characterized by AS in the management of Bosniak III and IV. Proper patient select, weighing the potential oncological benefit and the competing risks of death, is the key to ensuring adequate treatment for Bosniak III and IV renal cysts. […] Guidelines adopted AS as an alternative for managing renal complex cysts Bosniak III and IV.
#88 Update on adult renal cystic diseases | Applied Radiology
https://appliedradiology.com/articles/update-on-adult-renal-cystic-diseases
A wide spectrum of hereditary and non-hereditary disorders results in development of renal cysts in adult patients. […] Recent advances in genetics and molecular biology have shown that functional and structural abnormality of the primary cilia of the renal tubular epithelial cells subsequently lead to hereditary renal cystic diseases. […] Improved understanding of pathophysiologic mechanisms has led to development and testing of novel drugs for some of these diseases. […] In addition to diagnosis, imaging studies play a pivotal role in long-term surveillance, assessing prognosis, and testing efficacy of drugs. […] Imaging studies not only help in the diagnosis but also play an important role in the assessment of complications and long-term follow-up. […] MR imaging based renal cyst volumetry is an important tool in monitoring disease progression and assessing treatment response before renal function begins to decline.
#89 Update on adult renal cystic diseases | Applied Radiology
https://appliedradiology.com/articles/update-on-adult-renal-cystic-diseases
A wide spectrum of hereditary and non-hereditary disorders results in development of renal cysts in adult patients. […] Recent advances in genetics and molecular biology have shown that functional and structural abnormality of the primary cilia of the renal tubular epithelial cells subsequently lead to hereditary renal cystic diseases. […] Improved understanding of pathophysiologic mechanisms has led to development and testing of novel drugs for some of these diseases. […] In addition to diagnosis, imaging studies play a pivotal role in long-term surveillance, assessing prognosis, and testing efficacy of drugs. […] Imaging studies not only help in the diagnosis but also play an important role in the assessment of complications and long-term follow-up. […] MR imaging based renal cyst volumetry is an important tool in monitoring disease progression and assessing treatment response before renal function begins to decline.
#90 Update on adult renal cystic diseases | Applied Radiology
https://appliedradiology.com/articles/update-on-adult-renal-cystic-diseases
Continued increase in total kidney and cyst volume indicates progression of disease. […] At imaging, the presence of multiple simple and complex renal cysts interspersed with complex cystic and solid enhancing renal masses is characteristic of VHL. […] Management options for RCCs include continued surveillance and nephron-sparing procedures such as partial nephrectomy or image-guided radiofrequency/cryo ablation. […] Among all, VHL and ACKD have significantly increased risk of renal cell carcinoma and require long-term surveillance. […] Cross-sectional imaging studies not only aid in the detection and differentiation of various chronic adult renal cystic diseases but also play a significant role in the surveillance and follow-up of patients.
#91 Update on adult renal cystic diseases | Applied Radiology
https://appliedradiology.com/articles/update-on-adult-renal-cystic-diseases
Continued increase in total kidney and cyst volume indicates progression of disease. […] At imaging, the presence of multiple simple and complex renal cysts interspersed with complex cystic and solid enhancing renal masses is characteristic of VHL. […] Management options for RCCs include continued surveillance and nephron-sparing procedures such as partial nephrectomy or image-guided radiofrequency/cryo ablation. […] Among all, VHL and ACKD have significantly increased risk of renal cell carcinoma and require long-term surveillance. […] Cross-sectional imaging studies not only aid in the detection and differentiation of various chronic adult renal cystic diseases but also play a significant role in the surveillance and follow-up of patients.
#92 Active surveillance of small renal masses | Insights into Imaging | Full Text
https://insightsimaging.springeropen.com/articles/10.1186/s13244-020-00853-y
Most renal masses incidentally found by cross-sectional imaging are cysts which, according to the Bosniak renal cyst classification system, do not require follow-up. […] The use of contrast-enhanced ultrasound (CEUS) can help to differentiate benign renal lesions and thereby increase the number of lesions that do not need to be followed. […] AS is indicated only in SRMs which are regular in shape since masses with irregular borders are highly suspicious of being an aggressive tumor. […] The complexity of renal cysts is classified using the Bosniak renal cyst classification system, which was first applied in CT and MR and more recently in CEUS. […] According to the Bosniak classification system, a IIF cyst should be followed, while surgery is indicated for Bosniak III and IV cysts, despite the knowledge that 50% of Bosniak III cysts are benign.
#93 Cost-effectiveness of Ultrasound for Diagnosis and Surveillance of Complex Cystic Renal Lesions – American Urological Association
https://auanews.net/issues/articles/2023/february-extra-2023/upj-insight-cost-effectiveness-of-ultrasound-for-diagnosis-and-surveillance-of-complex-cystic-renal-lesions
Cystic renal masses are extremely common incidental findings on imaging. A significant proportion of these remain indeterminate and in appropriate clinical circumstances may be managed by active surveillance. Recent literature suggests that even these complex cysts are often indolent and slow growing. Precise stratification of these renal cysts is critical for active surveillance as misdiagnosis can lead to underdiagnosis or overtreatment with potential for harm to the patient and improper financial resource distribution and utilization. […] From our results, we believe ceUS can be a viable option for the active surveillance of complex renal masses, especially cystic masses.
#94 Cost-effectiveness of Ultrasound for Diagnosis and Surveillance of Complex Cystic Renal Lesions – American Urological Association
https://auanews.net/issues/articles/2023/february-extra-2023/upj-insight-cost-effectiveness-of-ultrasound-for-diagnosis-and-surveillance-of-complex-cystic-renal-lesions
Cystic renal masses are extremely common incidental findings on imaging. A significant proportion of these remain indeterminate and in appropriate clinical circumstances may be managed by active surveillance. Recent literature suggests that even these complex cysts are often indolent and slow growing. Precise stratification of these renal cysts is critical for active surveillance as misdiagnosis can lead to underdiagnosis or overtreatment with potential for harm to the patient and improper financial resource distribution and utilization. […] From our results, we believe ceUS can be a viable option for the active surveillance of complex renal masses, especially cystic masses.
#95 Cost-effectiveness of Ultrasound for Diagnosis and Surveillance of Complex Cystic Renal Lesions – American Urological Association
https://auanews.net/issues/articles/2023/february-extra-2023/upj-insight-cost-effectiveness-of-ultrasound-for-diagnosis-and-surveillance-of-complex-cystic-renal-lesions
Cystic renal masses are extremely common incidental findings on imaging. A significant proportion of these remain indeterminate and in appropriate clinical circumstances may be managed by active surveillance. Recent literature suggests that even these complex cysts are often indolent and slow growing. Precise stratification of these renal cysts is critical for active surveillance as misdiagnosis can lead to underdiagnosis or overtreatment with potential for harm to the patient and improper financial resource distribution and utilization. […] From our results, we believe ceUS can be a viable option for the active surveillance of complex renal masses, especially cystic masses.
#96 Cost-effectiveness of Ultrasound for Diagnosis and Surveillance of Complex Cystic Renal Lesions – American Urological Association
https://auanews.net/issues/articles/2023/february-extra-2023/upj-insight-cost-effectiveness-of-ultrasound-for-diagnosis-and-surveillance-of-complex-cystic-renal-lesions
Cystic renal masses are extremely common incidental findings on imaging. A significant proportion of these remain indeterminate and in appropriate clinical circumstances may be managed by active surveillance. Recent literature suggests that even these complex cysts are often indolent and slow growing. Precise stratification of these renal cysts is critical for active surveillance as misdiagnosis can lead to underdiagnosis or overtreatment with potential for harm to the patient and improper financial resource distribution and utilization. […] From our results, we believe ceUS can be a viable option for the active surveillance of complex renal masses, especially cystic masses.
#97 Surveillance of Complex Renal Cysts – the SOCRATIC Study
https://ctv.veeva.com/study/surveillance-of-complex-renal-cysts-the-socratic-study
The goal of this multicenter project is to conduct a prospective study with a 5-year follow-up to confirm the oncologic outcomes of active surveillance in the management of complex cysts. […] The main objectives are: 1) to compare the 5-year cancer specific survival between cysts managed by surgery and active surveillance; 2) to evaluate disease progression; 3) to evaluate patient’s well-being according to each management strategy; and 4) to compare the 5-year healthcare cost of both management approaches. […] Patients on active surveillance will also be assessed for cyst progression and might be offered invasive or systemic therapy if progression is observed.
#98 Surveillance of Complex Renal Cysts – the SOCRATIC Study | Clinical Research Trial Listing
https://www.centerwatch.com/clinical-trials/listings/NCT04558593/surveillance-of-complex-renal-cysts-the-socratic-study
One third of individuals aged 60 years will be diagnosed with at least one renal cyst following abdominal imaging. […] Growing evidence suggests that a significant proportion of Bosniak III and IV cysts are benign and that the malignant ones present low metastatic potential. […] Therefore, prospective studies of long-term follow-up are needed to confirm the oncologic safety of this strategy for patients with Bosniak III/IV cysts. […] The goal of this multicenter project is to conduct a prospective study with a 5-year follow-up to confirm the oncologic outcomes of active surveillance in the management of complex cysts. […] The main objectives are: 1) to compare the 5-year cancer specific survival between cysts managed by surgery and active surveillance; 2) to evaluate disease progression; 3) to evaluate patient’s well-being according to each management strategy; and 4) to compare the 5-year healthcare cost of both management approaches.
#99 Surveillance of Complex Renal Cysts – the SOCRATIC Study
https://ctv.veeva.com/study/surveillance-of-complex-renal-cysts-the-socratic-study
The goal of this multicenter project is to conduct a prospective study with a 5-year follow-up to confirm the oncologic outcomes of active surveillance in the management of complex cysts. […] The main objectives are: 1) to compare the 5-year cancer specific survival between cysts managed by surgery and active surveillance; 2) to evaluate disease progression; 3) to evaluate patient’s well-being according to each management strategy; and 4) to compare the 5-year healthcare cost of both management approaches. […] Patients on active surveillance will also be assessed for cyst progression and might be offered invasive or systemic therapy if progression is observed.
#100 Surveillance of Complex Renal Cysts – the SOCRATIC Study | Clinical Research Trial Listing
https://www.centerwatch.com/clinical-trials/listings/NCT04558593/surveillance-of-complex-renal-cysts-the-socratic-study
One third of individuals aged 60 years will be diagnosed with at least one renal cyst following abdominal imaging. […] Growing evidence suggests that a significant proportion of Bosniak III and IV cysts are benign and that the malignant ones present low metastatic potential. […] Therefore, prospective studies of long-term follow-up are needed to confirm the oncologic safety of this strategy for patients with Bosniak III/IV cysts. […] The goal of this multicenter project is to conduct a prospective study with a 5-year follow-up to confirm the oncologic outcomes of active surveillance in the management of complex cysts. […] The main objectives are: 1) to compare the 5-year cancer specific survival between cysts managed by surgery and active surveillance; 2) to evaluate disease progression; 3) to evaluate patient’s well-being according to each management strategy; and 4) to compare the 5-year healthcare cost of both management approaches.
#101 Surveillance of Complex Renal Cysts – the SOCRATIC Study
https://ctv.veeva.com/study/surveillance-of-complex-renal-cysts-the-socratic-study
One third of individuals aged 60 years will be diagnosed with at least one renal cyst following abdominal imaging. […] Growing evidence suggests that a significant proportion of Bosniak III and IV cysts are benign and that the malignant ones present low metastatic potential. […] Since renal surgery carries substantial morbidity (20%) and potential mortality (0.5%), active surveillance has gained attention as a potential tradeoff to surgery to overcome overtreatment. […] Therefore, prospective studies of long-term follow-up are needed to confirm the oncologic safety of this strategy for patients with Bosniak III/IV cysts. […] The main objective is to compare the 5-year follow-up cancer-specific survival between the active surveillance and the surgical groups. […] Thus, active surveillance which involves close follow-up of a patient’s condition, was proposed as a tradeoff option to surgery.
#102 Kidney | Benign Tumors & Cysts — Metrovan Urology
https://www.metrovanurology.com/kidney-benign-tumors-cysts
The Canadian Urological Association 2019 Guidline recommendations are as follows. […] Bosniak I (simple) renal cysts are common. These are almost never symptomatic regardless of size. The natural history of cysts is to grow over time and therefore growth should not necessarily be considered a sign of malignancy. Most importantly, transformation to a more complex cyst is very rare. Follow-up is not necessary or recommended. […] Bosniak II renal cysts are slightly more complex. Management is essentially the same as for Bosniak I renal cyst. […] Bosniak IIF renal cysts is an intermediate class of cysts which cannot clearly be placed into category II or III. […] Bosniak III renal cysts have an approximately 50% probability of harboring malignancy and surgical excision is generally recommended. […] Bosniak IV renal cysts have an 80-90% probability of harboring malignancy, typically cystic renal cell carcinoma. Excision is the treatment of choice though as most of low metastatic potential conservative management can be considered.
#103 Surveillance and clinical outcome of bosniak IIF renal cysts: a mini review – MedCrave online
https://medcraveonline.com/UNOAJ/surveillance-and-clinical-outcome-of-bosniak-iif-renal-cysts-a-mini-review.html
Based on studies that investigated the diagnosis, pathology and findings of Bosniak Type IIF and III cystic lesions, it was confirmed that approximately 30% of Bosniak IIF cysts are at risk of malignancy; consequently, prolonged monitoring for close to 5 years should be the standard form of treatment. […] Progressive Bosniak IIF lesions may be excised surgically. […] Imaging procedures on Bosniak IIF lesions fluctuates, depending largely on urologists and radiologists’ comprehension. […] The aim of imaging surveillance is to detect Bosniak IIF renal cysts that progress to higher class lesions, because higher reclassification is linked to higher class lesions. […] Frequent follow-up is inadequate among young patients. […] Nevertheless, intensive surveillance is the best way for monitoring the progress of Bosniak Class IIF cases.
#104 Active surveillance versus initial surgery in the long-term management of Bosniak IIFâIV cystic renal masses | Scientific Reports
https://www.nature.com/articles/s41598-022-14056-6
There may be surgical overtreatment of complex cystic renal masses (CRM). Growing evidence supports active surveillance (AS) for the management for Bosniak IIFIII CRMs. […] AS did not increase the risk of metastatic spread or cancer-specific mortality in patients with Bosniak IIFIV. Our data indicate AS in Bosniak IIF and III is safe. Surgery is the primary treatment for Bosniak IV due to its high malignancy rate. […] The risk of RCC varies between Bosniak categories. According to a meta-analysis by Schoots et al., RCC incidence was 618% for Bosniak IIF, 5155% for Bosniak III and 8991% for Bosniak IV CRMs. […] The current treatment recommendations are based on retrospective studies with small cohorts and short follow-up. […] The aim of the study was to evaluate the management, pathological and oncological outcomes of patients with Bosniak IIFIV CRMs in a large single center series.
#105 Active surveillance versus initial surgery in the long-term management of Bosniak IIFâIV cystic renal masses | Scientific Reports
https://www.nature.com/articles/s41598-022-14056-6
In conclusion, metastatic progression in Bosniak IIFIV CRMs is uncommon. AS does not increase the risk of metastatic spread or cancer-specific mortality of patients with Bosniak IIF III CRMs. Our results support the safety of AS in Bosniak IIF III CRMs and confirms surgery as the primary initial treatment for patients with Bosniak IV due to its associated high malignancy rate.
#106 Active surveillance versus initial surgery in the long-term management of Bosniak IIFâIV cystic renal masses | Scientific Reports
https://www.nature.com/articles/s41598-022-14056-6
There may be surgical overtreatment of complex cystic renal masses (CRM). Growing evidence supports active surveillance (AS) for the management for Bosniak IIFIII CRMs. […] AS did not increase the risk of metastatic spread or cancer-specific mortality in patients with Bosniak IIFIV. Our data indicate AS in Bosniak IIF and III is safe. Surgery is the primary treatment for Bosniak IV due to its high malignancy rate. […] The risk of RCC varies between Bosniak categories. According to a meta-analysis by Schoots et al., RCC incidence was 618% for Bosniak IIF, 5155% for Bosniak III and 8991% for Bosniak IV CRMs. […] The current treatment recommendations are based on retrospective studies with small cohorts and short follow-up. […] The aim of the study was to evaluate the management, pathological and oncological outcomes of patients with Bosniak IIFIV CRMs in a large single center series.
#107 Active surveillance versus initial surgery in the long-term management of Bosniak IIFâIV cystic renal masses | Scientific Reports
https://www.nature.com/articles/s41598-022-14056-6
In conclusion, metastatic progression in Bosniak IIFIV CRMs is uncommon. AS does not increase the risk of metastatic spread or cancer-specific mortality of patients with Bosniak IIF III CRMs. Our results support the safety of AS in Bosniak IIF III CRMs and confirms surgery as the primary initial treatment for patients with Bosniak IV due to its associated high malignancy rate.
#108 Complicated variation of simple renal cyst usually means malignancy: results from a cohort study | World Journal of Surgical Oncology | Full Text
https://wjso.biomedcentral.com/articles/10.1186/1477-7819-12-316
Regular follow-up is warranted in SRCs, and more attention should be paid to complicated variation of SRCs during surveillance, owing to the extremely high probability of malignancy. […] Ultrasound examination is highly recommended for SRCs every 6 months, and CT or MRI are also suggested, if possible. Upon confirmation of complicated variation, patients should be referred to surgery immediately; both radical nephrectomy and nephron-sparing surgery are acceptable.
#109 Kidney | Benign Tumors & Cysts — Metrovan Urology
https://www.metrovanurology.com/kidney-benign-tumors-cysts
The Canadian Urological Association 2019 Guidline recommendations are as follows. […] Bosniak I (simple) renal cysts are common. These are almost never symptomatic regardless of size. The natural history of cysts is to grow over time and therefore growth should not necessarily be considered a sign of malignancy. Most importantly, transformation to a more complex cyst is very rare. Follow-up is not necessary or recommended. […] Bosniak II renal cysts are slightly more complex. Management is essentially the same as for Bosniak I renal cyst. […] Bosniak IIF renal cysts is an intermediate class of cysts which cannot clearly be placed into category II or III. […] Bosniak III renal cysts have an approximately 50% probability of harboring malignancy and surgical excision is generally recommended. […] Bosniak IV renal cysts have an 80-90% probability of harboring malignancy, typically cystic renal cell carcinoma. Excision is the treatment of choice though as most of low metastatic potential conservative management can be considered.
#110 Active surveillance versus initial surgery in the long-term management of Bosniak IIFâIV cystic renal masses | Scientific Reports
https://www.nature.com/articles/s41598-022-14056-6
There may be surgical overtreatment of complex cystic renal masses (CRM). Growing evidence supports active surveillance (AS) for the management for Bosniak IIFIII CRMs. […] AS did not increase the risk of metastatic spread or cancer-specific mortality in patients with Bosniak IIFIV. Our data indicate AS in Bosniak IIF and III is safe. Surgery is the primary treatment for Bosniak IV due to its high malignancy rate. […] The risk of RCC varies between Bosniak categories. According to a meta-analysis by Schoots et al., RCC incidence was 618% for Bosniak IIF, 5155% for Bosniak III and 8991% for Bosniak IV CRMs. […] The current treatment recommendations are based on retrospective studies with small cohorts and short follow-up. […] The aim of the study was to evaluate the management, pathological and oncological outcomes of patients with Bosniak IIFIV CRMs in a large single center series.
#111 Active surveillance versus initial surgery in the long-term management of Bosniak IIFâIV cystic renal masses | Scientific Reports
https://www.nature.com/articles/s41598-022-14056-6
In conclusion, metastatic progression in Bosniak IIFIV CRMs is uncommon. AS does not increase the risk of metastatic spread or cancer-specific mortality of patients with Bosniak IIF III CRMs. Our results support the safety of AS in Bosniak IIF III CRMs and confirms surgery as the primary initial treatment for patients with Bosniak IV due to its associated high malignancy rate.
#112 Complicated variation of simple renal cyst usually means malignancy: results from a cohort study | World Journal of Surgical Oncology | Full Text
https://wjso.biomedcentral.com/articles/10.1186/1477-7819-12-316
Regular follow-up is warranted in SRCs, and more attention should be paid to complicated variation of SRCs during surveillance, owing to the extremely high probability of malignancy. […] Ultrasound examination is highly recommended for SRCs every 6 months, and CT or MRI are also suggested, if possible. Upon confirmation of complicated variation, patients should be referred to surgery immediately; both radical nephrectomy and nephron-sparing surgery are acceptable.