By Penelope A. Domogo, MD
Bosniaks are a South Slavic ethnic group native to the Southeast European historical region of Bosnia which is today part of Bosnia and Herzegovina, who share a common Bosnian ancestry, culture, history and language.” (Wikipedia) They have had a turbulent history. But we will not talk about them this time. The “Bosniak” that we will discuss in today’s column refers to the Bosniak classification system for renal (kidney) cysts.
This system of classification was developed in the late 1980s (so it wasn’t in our lessons in the 70’s) by Dr. Morton Bosniak, a pioneering radiologist and professor emeritus of radiology at New York University Langone School of Medicine. You see, medical technology advanced tremendously since the 1980s and these modern devices became popular with doctors. For example, x-ray advanced to more sophisticated imaging methods like ultrasound, CT scan (computed tomography) and MRI (magnetic resonance imaging). As a result of the popular use of these diagnostic methods, there are incidental findings whose classification and management are not easy, like that of renal cysts. What I mean is that, for example, a patient has a problem of chronic constipation so the doctor orders a CT scan of the abdomen to see what’s the problem. The CT scan does not show any abnormal findings in the stomach and intestines but shows a cyst in the kidney. The kidney cyst is an incidental finding. This is where the Bosniak classification comes in.
This Bosniak classification has undergone revisions and was last updated in 2005. There’s a proposed Bosniak classification, version 2019, but is not widely used. This classification is intended to improve the ability of radiologists and other physicians to differentiate benign from cancerous renal cysts so unnecessary surgery is avoided and thus protect healthy kidneys. So here’s the Bosniak classification system of renal cystic masses, (version 2005) (by Calum Worsley February 17, 2024, Radiopaedia):
Bosniak I – benign simple cyst, no work-up needed, percentage malignant 0%
(“benign” is another term for “not cancerous”)
Bosniak II – benign cyst, minimally complex; no work-up needed; percentage malignant 0-6%
Bosniak IIF – minimally complex; requires follow-up ultrasound/CT/MRI;
percentage malignant 5-26%
Bosniak III – indeterminate cystic mass; treatment is partial nephrectomy or radiofrequency
ablation in poor surgical candidates; percentage malignant 55- 72%
Bosniak IV – clearly malignant cystic mass; treatment is partial or total nephrectomy (surgical
removal or partial removal of the affected kidney); percentage malignant 91-100%.
Kidney or renal cysts are usually simple and don’t cause any symptoms – Bosniak I or II – so doctors just leave them there. There’s no definite answer as to what causes renal cysts or what makes them grow. But we all know and science also knows that our lifestyle, especially our modern food and drink, smoking and artificial chemicals are linked to modern diseases. So the best thing to do is…. to take care of your lifestyle- natural food and drink , enough exercise, positive attitude, healthy relationships, no smoking, trust in a loving Supreme Being.***
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“Trust in the Lord with all your heart and lean not on your understanding; in all your ways submit to him and he will make your paths straight.” Proverbs 3:5-6**
