Pathological and Clinical Outcomes in a Large Surveillance and Intervention Cohort of Radiographically Cystic Renal Masses

Randall A. Lee, Robert G. Uzzo, Jordan Anaokar, Ashanth Thomas, Shuanzeng Wei, Benjamin T. Ristau, Andrew Mcintosh, Matthew Lee, David Y.T. Chen, Richard E. Greenberg, Rosalia Viterbo, Marc C. Smaldone, Andres Correa, Jared Schober, Kevin Ginsburg, Laura Bukavina, Diana Magee, Nicole Uzzo, Phyllis Parkansky, Karen RuthAlexander Kutikov

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Purpose: We evaluated oncologic risks in a large cohort of patients with radiographic cystic renal masses who underwent active surveillance or intervention. Materials and Methods: A single-institutional database of 4,340 kidney lesions managed with either active surveillance or intervention between 2000-2020 was queried for radiographically cystic renal masses. Association of radiographic tumor characteristics and high-grade pathology was evaluated. Results: We identified 387 radiographically confirmed cystic lesions in 367 patients. Of these, 247 were resected (n=240) or ablated (n=7; n=247, 203 immediate vs 44 delayed intervention). Pathologically, 23% (n=56) demonstrated high-grade pathology. Cystic features were explicitly described by pathology in only 18% (n=33) of all lesions and in 7% (n=4) of high-grade lesions. Of the intervention cohort, African American race, male gender, and Bosniak score were associated with high-grade pathology (P <.05). On active surveillance (n=184), Bosniak IV lesions demonstrated faster growth rates than IIF and III lesions (2.7 vs 0.6 and 0.5 mm/y, P ≤.001); however, growth rates were not associated with high-grade pathology (P =.5). No difference in cancer-specific survival was identified when comparing intervention vs active surveillance at 5 years (99% vs 100%, P =.2). No difference in recurrence was observed between immediate intervention vs delayed intervention (P >.9). Conclusions: A disconnect between "cystic"designation on imaging and pathology exists for renal lesions. Over 80% of radiographic Bosniak cystic lesions are not described as "cystic"on pathology reports. More than 1 in 5 resected cystic renal lesions demonstrated high-grade disease. Despite this finding, judiciously managed active surveillance ± delayed intervention is a safe and effective management option for most radiographic cystic renal masses.

Original languageEnglish
Pages (from-to)686-693
Number of pages8
JournalJournal of Urology
Issue number4
StatePublished - Apr 1 2023


  • carcinoma
  • kidney diseases, cystic
  • renal cell
  • treatment outcome


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