Objectives: The aims of this study are to determine the progression rate of Bosniak IIF cysts, the malignancy rates of complex renal cysts in patients undergoing surgery and explore the influence of multi-disciplinary team conference (MDT) on re-classification of Bosniak cysts. Materials and Methods: All CT scans from January 2010 to 2017 were pooled into a database. Initially, 167 patients were identified with possible Bosniak IIF, III or IV cysts. Patients with follow up of less than 24 months, without progression or regression were excluded. Results: Thirty-one (18.6%) cysts of the initial 167 cysts were either up or downgraded at a MDT. Twenty-six of the 31 cysts were up or downgraded at the primary MDT, 13 cysts (50%) were downgraded, five cysts (19.2%) were upgraded and eight cysts (30.8%) were re-classified as solid tumors. Of those 19/26 (73.1%) were primary interpreted by a periphery radiologist and re-classified centrally. The last five patients 5/120 cysts (4.2%) were re-classified during follow up. 116 patients with a total of 120 cysts met the inclusion criteria, 79 (65.8%) Bosniak IIF, 28 (23.3%) Bosniak III and 13 (10.8%) Bosniak IV cysts represented. Median follow up of Bosniak IIF cysts were 46 months. One Bosniak IIF cyst progressed to a solid tumor at 15 months from diagnosis, progression rate 1.3%. Histopathology was papillary renal cell carcinoma. Malignancy rates of Bosniak III and IV cysts were 50% and 78%, respectively. Conclusion: Multi-disciplinary team conference may have an important role in correct classification of Bosniak cysts. Trial registration: None.