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World Journal of Urology

, Volume 33, Issue 6, pp 853–858 | Cite as

Interobserver variability of R.E.N.A.L., PADUA, and centrality index nephrometry score systems

  • Massimiliano Spaliviero
  • Bing Ying Poon
  • Omer Aras
  • Pier Luigi Di Paolo
  • Giuliano B. Guglielmetti
  • Christian Z. Coleman
  • Christoph A. Karlo
  • Melanie L. Bernstein
  • Daniel D. Sjoberg
  • Paul Russo
  • Karim A. Touijer
  • Oguz Akin
  • Jonathan A. ColemanEmail author
Original Article

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.

Keywords

Kidney neoplasms Nephrometry Observer variability Partial nephrectomy Outcome assessment 

Abbreviations

ASA

American Society of Anesthesiologists

C-Index

Centrality index

CI

Confidence interval

CT

Computed tomography

CKD-EPI

Chronic Kidney Disease Epidemiology Collaboration

CT

Computed tomography

eGFR

Estimated glomerular filtration rate

ICC

Intraclass correlation coefficient

IOV

Interobserver variability

IQR

Interquartile range

MSKCC

Memorial Sloan Kettering Cancer Center

NMS

Non-medical secondary school student

NS

Nephrometry sum

PADUA

Preoperative aspects and dimensions used for an anatomical classification system

PHYS

Physicians (urology fellows + radiology resident)

PN

Partial nephrectomy

R.E.N.A.L.

Radius, exophytic/endophytic, nearness, anterior/posterior, location

RFEL

Radiology fellow

Notes

Acknowledgments

Supported in part by NIH/NCI Cancer Center Support Grant to MSKCC (award number P30 CA008748) and The Thompson Family Foundation. The manuscript does not contain clinical studies or patient data.

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Massimiliano Spaliviero
    • 1
  • Bing Ying Poon
    • 2
  • Omer Aras
    • 3
  • Pier Luigi Di Paolo
    • 3
  • Giuliano B. Guglielmetti
    • 1
  • Christian Z. Coleman
    • 1
  • Christoph A. Karlo
    • 3
  • Melanie L. Bernstein
    • 1
  • Daniel D. Sjoberg
    • 2
  • Paul Russo
    • 1
  • Karim A. Touijer
    • 1
  • Oguz Akin
    • 3
  • Jonathan A. Coleman
    • 1
    • 4
    Email author
  1. 1.Department of Surgery, Urology ServiceMemorial Sloan Kettering Cancer CenterNew YorkUSA
  2. 2.Department of Epidemiology and BiostatisticsMemorial Sloan Kettering Cancer CenterNew YorkUSA
  3. 3.Department of RadiologyMemorial Sloan Kettering Cancer CenterNew YorkUSA
  4. 4.Department of Surgery, Sidney Kimmel Center for Prostate and Urologic CancersMemorial Sloan Kettering Cancer CenterNew YorkUSA

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