肾脏囊性占位 2013年11月.pptVIP

肾脏囊性占位 2013-11 Introduction Ignore, Follow or ExciseRadiological InterpretationCalcificationHyperdense or High signalSeptationsEnhancementMultiloculatedNodularityWall thickeningRole of BiopsyDr Bosniaks opinionBosniak Classification of Renal Cystic Disease Even on gross examination a cystic renal cell carcinoma (left) may be indistinguishable from a complicated cyst (right) Ignore, Follow or Excise Renal cysts can be classified according to the Bosniak classification depending on their features.?Type I?cysts are simple cysts.Type II?are the minimally complicated cysts.?Type I and II can be ignored.?Type II F?are probably benign, but need to be followed.?Type III and IV?both are surgical lesions.?Type IV is inevitably malignant and in the type III group about 80-90% turn out to be malignant as well. In our communication with the clinicians it is important, that we explain the significance of our findings and the meaning of the classification in terms of: Ignore (type I and II), Follow (type IIF) or Excise (type III and IV).So in this lecture we will only talk about Ignore, Follow or Excise.For those who want to see the original Bosniak classification, look at the table which is presented at the end of the lecture. Radiological Interpretation Although the final differentiation of cystic renal masses is based upon histologic diagnosis, there are imaging findings that tell you that a cyst is not a simple cyst and whether it is probably benign or malignant. The following imaging features indicate that a cyst is NOT simple:- Calcification- Hyperdense / high signal- Septations- Multiple locules- Enhancement- Nodularity / wall thickening Differentiation is based upon histologic diagnosis, but Imaging is a reliable means for differentiating benign from malignant cystic lesions The table on the left summarises these imaging features together with the management consequences: Ignore, Follow or Excise. When we look at these imaging features, we have