CT Bosniak分级对肾囊性病变良恶性鉴别诊断的价值：单中心回顾性研究

CT Bosniak Classification for Differential Diagnosis of Benign and Malignant Renal Cystic Lesions: A Single-Center Retrospective Study

摘要: 目的：评估CT Bosniak 2019版分级系统对肾囊性病变良恶性鉴别诊断的临床价值。方法：回顾性分析2020年1月至2025年10月于我院收治的163例经CT增强扫描评估为II级及以上肾囊性病变患者的影像及病理资料，以术后病理为金标准，计算各分级恶性率、诊断敏感度、特异度、阳性预测值、阴性预测值及准确度，绘制ROC曲线确定最佳恶性分级。结果：II级、IIF级、III级、IV级恶变率分别为7.8% (4/51)、17.8% (8/45)、60.6% (20/33)、97.1% (33/34)，呈显著递增趋势(P < 0.001)。以III级及以上为恶性诊断标准，敏感度为81.5%，特异度为85.7%，阳性预测值为79.1%，阴性预测值为87.5%，准确度为84.0%。III级病变中良性占比39.4%，IV级病变中仅1例(2.9%)为良性。结论：CT Bosniak 2019版分级系统对肾囊性病变良恶性鉴别具有很高的临床价值。III级及以上病变恶性风险极高，应积极手术；II级及IIF级病变恶性率低，推荐影像随访。本研究结果支持Bosniak 2019分级系统在中国人群中的临床应用价值，但其在低风险病变中的确切恶性率仍需更大规模、包含随访队列的研究来证实。

Abstract: Objective: To evaluate the clinical value of the 2019 version of the CT Bosniak classification system in the differential diagnosis of benign and malignant renal cystic lesions. Methods: A retrospective analysis was conducted on the imaging and pathological data of 163 patients with renal cystic lesions classified as grade II or higher by contrast-enhanced CT scanning at our hospital from January 2020 to October 2025. Using postoperative pathology as the gold standard, the malignancy rate for each Bosniak grade was calculated, along with diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. A receiver operating characteristic (ROC) curve was plotted to determine the optimal cutoff grade for malignancy. Results: The malignancy rates for grades II, IIF, III, and IV were 7.8% (4/51), 17.8% (8/45), 60.6% (20/33), and 97.1% (33/34), respectively, showing a significant increasing trend (P<0.001). Using grade III or higher as the diagnostic criterion for malignancy, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 81.5%, 85.7%, 79.1%, 87.5%, and 84.0%, respectively. Among grade III lesions, 39.4% were benign, while only one case (2.9%) was benign among grade IV lesions. Conclusion: The 2019 version of the CT Bosniak classification system has high clinical value in differentiating benign from malignant renal cystic lesions. Lesions of grade III or higher carry a very high risk of malignancy and warrant active surgical intervention, whereas grade II and IIF lesions have low malignancy rates and are recommended for imaging follow-up. The findings of this study support the clinical utility of the Bosniak 2019 classification system in the Chinese population, but its exact malignancy rate in low-risk lesions still requires confirmation through larger-scale studies incorporating follow-up cohorts.