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Bosniak classification system of renal cystic masses

Dr Balint Botz ◉ and A.Prof Frank Gaillard ◉ ◈ et al.

The Bosniak classification system of renal cystic masses divides renal cystic masses into five categories based on imaging characteristics on contrast-enhanced CT. It is helpful in predicting a risk of malignancy and suggesting either follow up or treatment.

Classification

Bosniak I

simple cyst
- imperceptible wall, rounded
- work-up: none
- percentage malignant: ~0%

Bosniak II

minimally complex
- a few thin <1 mm septa or thin calcifications (thickness not measurable);
- non-enhancing high-attenuation (due to proteinaceous or hemorrhagic contents) renal lesions <3 cm
- these lesions are generally well marginated
- work-up: none
- percentage malignant: ~0%

Bosniak IIF

minimally complex
- increased number of septa, minimally thickened with nodular or thick calcifications
- there may be perceived (but not measurable) enhancement of hairline-thin smooth septa
- minimal thickening of the wall with perceivable enhancement
- hyperdense cyst >3 cm diameter, mostly intrarenal (less than 25% of wall visible); no enhancement
- requiring follow-up (the 'F' in 2F is for 'follow'): needs ultrasound/CT/MRI follow up - no strict rules on the time frame but reasonable at 6 months
- percentage malignant: ~5% ⁶

Bosniak III

indeterminate
- thick, nodular multiple septa or wall with measurable enhancement
- treatment/work-up: partial nephrectomy or radiofrequency ablation in elderly or poor surgical candidates
- percentage malignant: ~55% ⁶

Bosniak IV

clearly malignant
- solid mass with a large cystic or a necrotic component
- treatment: partial or total nephrectomy
- percentage malignant: ~100%

History and etymology

It is named after Morton A Bosniak (1929-2016), who was professor emeritus in radiology at New York University (NYU) Langone School of Medicine ^9,10.

References

Renal cystic disease

Article information

rID: 1006

System: Urogenital

Section: Classifications

Tag: kidney

Synonyms or Alternate Spellings:

Bosniak classification system of renal cysts
Bosniak renal cyst classification system
Bosniak renal cyst classification
Bosniak classification system of renal cystic lesions

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Cases and figures

Figure 1 Figure 1

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Case 1: Bosniak grade 1 Case 1: Bosniak grade 1

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Case 2: Bosniak grade 1Case 2: Bosniak grade 1

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Case 3: Bosniak grade 2 - hemorrhagic cystCase 3: Bosniak grade 2 - hemorrhagic cyst

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Case 4: Bosniak grade 2Case 4: Bosniak grade 2

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Case 5: Bosniak grade 2Case 5: Bosniak grade 2

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Case 6: Bosniak grade 2Case 6: Bosniak grade 2

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Case 7: Bosniak grade 3 - with enhancing mural noduleCase 7: Bosniak grade 3 - with enhancing mural nodule

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Case 8: Bosniak grade 4Case 8: Bosniak grade 4

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Case 9: Bosniak grade 4Case 9: Bosniak grade 4

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Case 10: Bosniak grade 4Case 10: Bosniak grade 4

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Case 11: Bosniak type 4 cyst on a background of APKDCase 11: Bosniak type 4 cyst on a background of APKD

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Case 12: Bosniak grade 4Case 12: Bosniak grade 4

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Case 13: Bosniak grade 2 (CEUS)Case 13: Bosniak grade 2 (CEUS)

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