Article ; Online: Interobserver variability of R.E.N.A.L., PADUA, and centrality index nephrometry score systems.
2014 Volume 33, Issue 6, Page(s) 853–858
Abstract: Purpose: To assess interobserver variability of R.E.N.A.L., preoperative aspects and dimensions ... ICC = 0.773) was higher than with PADUA (ICC = 0.677) or R.E.N.A.L (ICC = 0.660). Agreement between ... 016). Tumor size, nearness to sinus, and location relative to polar lines (R.E.N.A.L.) and tumor size ...
| Abstract | Purpose: To assess interobserver variability of R.E.N.A.L., preoperative aspects and dimensions used for an anatomical classification system (PADUA), and centrality index (C-Index) systems among observers with varying degrees of clinical experience and each system's subscale correlation with surgical outcome metrics. Methods: Computed tomography images of 90 patients who underwent open, laparoscopic, or robot-assisted laparoscopic partial nephrectomy were scored by one radiology fellow, two urology fellows, one radiology resident, and one secondary school student. Agreement among readers was determined calculating intraclass correlation coefficients. Associations between radiology fellow scores (reference standard as reader with greatest clinical experience), ischemia time, and percent change in postoperative estimated glomerular filtration rate (eGFR) were evaluated using Spearman's correlation. Results: Agreement using C-Index method (ICC = 0.773) was higher than with PADUA (ICC = 0.677) or R.E.N.A.L (ICC = 0.660). Agreement between reference and secondary school student was lower than with other physicians, although the differences were not statistically significant. The reference's scores were significantly (p < 0.05) associated with ischemia time on all three scoring systems and with percent change in eGFR at 6 weeks using C-Index (p = 0.016). Tumor size, nearness to sinus, and location relative to polar lines (R.E.N.A.L.) and tumor size, renal sinus involvement, and collecting system involvement (PADUA) correlated with ischemia time (all p ≤ 0.001). No R.E.N.A.L. or PADUA subscales significantly correlated with percent change in postoperative eGFR. Conclusions: Clinical experience reduces interobserver variability of existing nephrometry systems though not significantly and less so when using directly measureable anatomic variables. Consistently, only measures of tumor size and distance to intrarenal structures were useful in predicting clinically relevant outcomes. |
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| MeSH term(s) | Aged ; Anthropometry ; Carcinoma, Renal Cell/diagnostic imaging ; Carcinoma, Renal Cell/pathology ; Carcinoma, Renal Cell/surgery ; Cohort Studies ; Fellowships and Scholarships ; Female ; Humans ; Internship and Residency ; Kidney/diagnostic imaging ; Kidney Neoplasms/diagnostic imaging ; Kidney Neoplasms/pathology ; Kidney Neoplasms/surgery ; Laparoscopy ; Male ; Middle Aged ; Nephrectomy ; Observer Variation ; Outcome Assessment, Health Care ; Radiology/education ; Retrospective Studies ; Robotic Surgical Procedures ; Schools ; Students ; Tomography, X-Ray Computed ; Tumor Burden ; Urology/education |
| Language | English |
| Publishing date | 2014-08-24 |
| Publishing country | Germany |
| Document type | Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't |
| ZDB-ID | 380333-8 |
| ISSN | 1433-8726 ; 0724-4983 |
| ISSN (online) | 1433-8726 |
| ISSN | 0724-4983 |
| DOI | 10.1007/s00345-014-1376-4 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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