Reproducibility of Fuhrman Nuclear Grading of Renal Cell Carcinoma: A Preliminary Study

Background: The aim of this study was to evaluate intraobserver and interobserver reproducibility of Fuhrman nuclear grading of renal cell carcinoma. Methods: Pathology slides from 46 cases of renal cell carcinoma were rescored by 2 pathologists according to the Fuhrman system. Both intraobserver and interobserver reproducibility were assessed using kappa statistics. Results: The initial Fuhrman grade was grade 1 in 4 of the cases (8.7%), grade 2 in 30 (65.2%), grade 3 in 11 (23.9%), and grade 4 in 1 (2.2%). After reviewing the slides by the same pathologist, grades were reassigned as follows: grade 1 in 8 cases (17.4%), grade 2 in 23 (50%), grade 3 in 14 (30.4%), and grade 4 in 1 (2.2%). Intraobserver reproducibility of the Fuhrman system was substantial (k = 0.66). Fuhrman grading by the second pathologist was grade 1 in 11 cases (23.9%), grade 2 in 27 (58.7%), grade 3 in 7 (15.2%), and grade 4 in 1 (2.2%). Interobserver reproducibility of the Fuhrman system was moderate (k = 0.42). Conclusions: Despite substantial intraobserver reproducibility of Fuhrman grading, moderate interobserver reproducibility and low agreement for grade 3 should be a consideration.

Reproducibility of Fuhrman Nuclear Grading of Renal Cell Carcinoma: A Preliminary Study

Background: The aim of this study was to evaluate intraobserver and interobserver reproducibility of Fuhrman nuclear grading of renal cell carcinoma. Methods: Pathology slides from 46 cases of renal cell carcinoma were rescored by 2 pathologists according to the Fuhrman system. Both intraobserver and interobserver reproducibility were assessed using kappa statistics. Results: The initial Fuhrman grade was grade 1 in 4 of the cases (8.7%), grade 2 in 30 (65.2%), grade 3 in 11 (23.9%), and grade 4 in 1 (2.2%). After reviewing the slides by the same pathologist, grades were reassigned as follows: grade 1 in 8 cases (17.4%), grade 2 in 23 (50%), grade 3 in 14 (30.4%), and grade 4 in 1 (2.2%). Intraobserver reproducibility of the Fuhrman system was substantial (k = 0.66). Fuhrman grading by the second pathologist was grade 1 in 11 cases (23.9%), grade 2 in 27 (58.7%), grade 3 in 7 (15.2%), and grade 4 in 1 (2.2%). Interobserver reproducibility of the Fuhrman system was moderate (k = 0.42). Conclusions: Despite substantial intraobserver reproducibility of Fuhrman grading, moderate interobserver reproducibility and low agreement for grade 3 should be a consideration.

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  • 1. Eble JN, Togashi K, Pisani P. Renal cell carcinoma. In: Eble JN, Sauter G, Epstein JI, Sesterhenn IA, editors. World Health Organization Classification of Tumours. Pathology and genetics of tumours of the urinary system and male genital organs, Lyon: IARC Press; 2004. p: 12-14.
  • 2. Kontak JA, Campbell SC. Prognostic factors of renal cell carcinoma. Urol Clin North Am 2003; 30: 467-480.
  • 3. Novara G, Mortignoni G, Artibani W, Ficarra V. Grading systems in renal cell carcinoma. J Urol 2007; 177: 430-436.
  • 4. Gudbjartsson T, Hardarson S, Petursdottir V, Thoroddsen A, Magnusson J, Einarsson GV. Histological subtyping and nuclear grading of renal cell carcinoma and their implications for survival: A retrospective nation-wide study of 629 patients. Eur Urol 2005; 48: 593-600.
  • 5. Rioux-Leclercq N, Karakiewicz PI, Trinh QD, Ficarra V, Cindolo L, Taille A et al. Prognostic ability of simplified nuclear grading of renal cell carcinoma. Cancer 2007; 109: 868-874.
  • 6. Skinner DG, Colvin RB, Vermillion CD, Pfister RC, Leadbetter WF. Diagnosis and management of renal cell carcinoma. A clinical and pathologic study of 309 cases. Cancer 1971; 28: 1165-1177.
  • 7. Fuhrman SA, Lasky LC, Limas C. Prognostic significance of morphologic parameters in renal cell carcinoma. Am J Surg Pathol 1982; 6: 655-663.
  • 8. Bostwick DG, Murphy GP. Diagnosis and prognosis of renal cell carcinoma: highlights from an international consensus workshop. Semin Urol Oncol 1998; 16: 46-52.
  • 9. Medeiros LC, Jones EC, Aizawa S, Aldape HC, Cheville JC, Goldstein NS. Grading of renal cell carcinoma. Workgroup no.2. Cancer 1997; 80: 990-991.
  • 10. Minervini A, Lilas L, Minervini R, Selli C. Prognostic value of nuclear grading in patients with intracapsular (pT1-pT2) renal cell carcinoma. Long- term analysis in 213 patients. Cancer 2002; 94: 2590-2595.
  • 11. Di Silverio F, Casale P, Colella D, Andrea L, Seccareccia F, Sciarra A. Independent value of tumor size and DNA ploidy for the prediction of disease progression in patients with organ-confined renal cell carcinoma. Cancer 2000; 88: 835-843.
  • 12. Usubutun A, Uygur MC, Ayhan A, Toklu C, Sahin A, Ozen H et al. Comparison of grading systems for estimating the prognosis of renal cell carcinoma. Int Urol Nephrol 1998; 30: 391-397.
  • 13. Medeiros LC, Gelb AB, Weiss LM. Renal cell carcinoma, Prognostic significance of morphologic parameters in 121 cases. Cancer 1998; 61: 1639-1651.
  • 14. Yasunaga Y, Shin M, Miki T, Okuyama A, Aozasa K. Prognostic factors of renal cell carcinoma: A multivariate analysis. J Surg Oncol 1998; 68: 11-18.
  • 15. Ficarra V, Righetti R, Martignoni G, D’Amico A, Pilloni S, Rubilotta E et al. Prognostic value of renal cell carcinoma nuclear grading: multivariate analysis of 333 cases. Urol Int 2001; 67: 130-134.
  • 16. Ficarra V, Righetti R, Pilloni S, D’Amico A, Maffei N, Novella G et al. Prognostic factors in patients with renal cell carcinoma: retrospective analysis of 675 cases. Eur Urol 2002; 41: 190-198.
  • 17. Ficarra V, Martignoni G, Maffei N, Brunelli M, Novara G, Zanolla L et al. Original and reviewed nuclear grading according to the Fuhrman system. A multivariate analysis of 388 patients with conventional renal cell carcinoma. Cancer 2005; 103: 68-75.
  • 18. Lanigan D, Conroy R, Barry-Walsh C, Loftus B, Royston D, Leader M. A comparative analysis of grading systems in renal adenocarcinoma. Histopathology 1994; 24: 473-476.
  • 19. Al- Aynati M, Chen V, Salama S, Shuhaibar H, Treleaven D, Vincic L. Interobserver and intraobserver variability using the Fuhrman Grading system for renal cell carcinoma. Arch Pathol Lab Med 2003; 127: 593-596.
  • 20. Lang H, Lindner V, de Fromont M, Molinie V, Letourneux H, Meyer N et al. Multicenter determination of optimal interobserver agreement using the Fuhrman grading system for renal cell carcinoma. Assessment of 241 patients with > 15-year follow up. Cancer 2005; 103: 625-629.
  • 21. Bretheau D, Lechevallier E, de Fromont M, Sault MC, Rampal M, Coulange C. Prognostic value of nuclear grade of renal cell carcinoma. Cancer 1995; 76: 2543-2549.
  • 22. Lohse CM, Blute ML, Zincke H, Weaver AL, Cheville JC. Comparison of standardized and nonstandardized nuclear grade of renal cell carcinoma to predict outcome among 2,042 patients. Am J Clin Pathol 2002; 118: 877-886.
  • 23. Carducci MA, Piantadosi S, Pound CR, Epstein JI, Simons JW, Marshall FF et al. Nuclear morphometry adds significant prognostic information to stage and grade for renal cell carcinoma. Urology 1999; 53: 44-49.
  • 24. Montironi R, Santinelli A, Pomante R, Mazzucchelli R, Colanzi P, Filho AL et al. Morphometric index of adult renal cell carcinoma. Comparison with the Fuhrman grading system. Virchows Arch 2000; 437: 82-89.
Turkish Journal of Medical Sciences-Cover
  • ISSN: 1300-0144
  • Yayın Aralığı: Yılda 6 Sayı
  • Yayıncı: TÜBİTAK
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