Question: 20200059

Status


Final

Category


#1:   Reportability
#2:   Kidney, renal pelvis
#3:  


References


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Source 2:  
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Question


Reportability--Kidney:  Is Bosniak 4 cystic lesion of right kidney reportable, and would the first CT date be the date of diagnosis?  See Discussion.



Discussion


CT a/p read by radiologist shows: "Bosniak 4 cystic lesion of right kidney." Follow-up MRI a month later reads "right kidney cystic lesion with enhancing mural nodule… concerning for cystic renal cell carcinoma (RCC)." Urologist consult used the same wording of "Bosniak 4 cystic lesion" and "concerning for renal cell carcinoma." Treatment discussed but due to patient health status recommended repeat imaging. Repeat CT few months later reads: "cystic right renal lesion with enhancing nodule… similar to most recent prior and suspicious for cystic RCC."

Though "suspicious for cystic RCC" per latest imaging is reportable, Bosniak 4 is "clearly malignancy, ~100% malignant" by definition, so is the case actually reportable with the first CT a/p date as date of diagnosis?



Answer


Bosniak 4 is defined as "clearly malignant; ~100% malignant." The case is reportable as of the first date it is diagnosed as a Bosniak 4 lesion unless further workup (especially biopsy or resection) disproves the CT findings.



History




Last Updated


10/29/2020

Date Finalized


12/14/2020