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. 2022 Oct 18:12:931592.
doi: 10.3389/fonc.2022.931592. eCollection 2022.

Diagnostic performance of the Bosniak classification, version 2019 for cystic renal masses: A systematic review and meta-analysis

Qing Zhang  1 , Xiaoli Dai  1 , Wei Li  1
Affiliations

Diagnostic performance of the Bosniak classification, version 2019 for cystic renal masses: A systematic review and meta-analysis

Qing Zhang et al. Front Oncol. .

Abstract

Purpose: To systematically assess the diagnostic performance of the Bosniak classification, version 2019 for risk stratification of cystic renal masses.

Methods: We conducted an electronic literature search on Web of Science, MEDLINE (Ovid and PubMed), Cochrane Library, EMBASE, and Google Scholar to identify relevant articles between June 1, 2019 and March 31, 2022 that used the Bosniak classification, version 2019 for risk stratification of cystic renal masses. Summary estimates of sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-), and diagnostic odds ratio (DOR) were pooled with the bivariate model and hierarchical summary receiver operating characteristic (HSROC) model. The quality of the included studies was assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool.

Results: A total of eight studies comprising 720 patients were included. The pooled sensitivity and specificity were 0.85 (95% CI 0.79-0.90) and 0.68 (95% CI 0.58-0.76), respectively, for the class III/IV threshold, with a calculated area under the HSROC curve of 0.84 (95% CI 0.81-0.87). The pooled LR+, LR-, and DOR were 2.62 (95% CI 2.0-3.44), 0.22 (95% CI 0.16-0.32), and 11.7 (95% CI 6.8-20.0), respectively. The Higgins I 2 statistics demonstrated substantial heterogeneity across studies, with an I 2 of 57.8% for sensitivity and an I 2 of 74.6% for specificity. In subgroup analyses, the pooled sensitivity and specificity for CT were 0.86 and 0.71, respectively, and those for MRI were 0.87 and 0.67, respectively. In five studies providing a head-to-head comparison between the two versions of the Bosniak classification, the 2019 version demonstrated significantly higher specificity (0.62 vs. 0.41, p < 0.001); however, it came at the cost of a significant decrease in sensitivity (0.88 vs. 0.94, p = 0.001).

Conclusions: The Bosniak classification, version 2019 demonstrated moderate sensitivity and specificity, and there was no difference in diagnostic accuracy between CT and MRI. Compared to version 2005, the Bosniak classification, version 2019 has the potential to significantly reduce overtreatment, but at the cost of a substantial decline in sensitivity.

Keywords: Bosniak classification; ct; cystic renal masses; mri; systematic review.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Study selection process for the systematic review and meta-analysis.
Figure 2
Figure 2
Grouped bar charts showing the risk of bias and concerns regarding the applicability of the included studies.
Figure 3
Figure 3
Coupled forest plot of pooled sensitivity and specificity. The numbers are pooled estimates; the 95% CI appears in parentheses. Corresponding heterogeneity statistics are provided in the bottom right corners. Horizontal lines indicate 95% confidence intervals.
Figure 4
Figure 4
The Deeks’ funnel plot.
Figure 5
Figure 5
HSROC plots with summary point and 95% confidence area for the overall.
Figure 6
Figure 6
Summary receiver operating characteristic (ROC) performance curves for the Bosniak classification, version 2019 and version 2005.
See this image and copyright information in PMC

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