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

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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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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

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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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Authors and Affiliations

  1. Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    Massimiliano Spaliviero, Giuliano B. Guglielmetti, Christian Z. Coleman, Melanie L. Bernstein, Paul Russo, Karim A. Touijer & Jonathan A. Coleman

  2. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    Bing Ying Poon & Daniel D. Sjoberg

  3. Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    Omer Aras, Pier Luigi Di Paolo, Christoph A. Karlo & Oguz Akin

  4. Department of Surgery, Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    Jonathan A. Coleman

Authors
  1. Massimiliano Spaliviero
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  2. Bing Ying Poon
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  3. Omer Aras
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  4. Pier Luigi Di Paolo
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  5. Giuliano B. Guglielmetti
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  6. Christian Z. Coleman
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  7. Christoph A. Karlo
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  8. Melanie L. Bernstein
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  9. Daniel D. Sjoberg
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  10. Paul Russo
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  13. Jonathan A. Coleman
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Corresponding author

Correspondence to Jonathan A. Coleman.

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Spaliviero, M., Poon, B.Y., Aras, O. et al. Interobserver variability of R.E.N.A.L., PADUA, and centrality index nephrometry score systems. World J Urol 33, 853–858 (2015). https://doi.org/10.1007/s00345-014-1376-4

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  • DOI: https://doi.org/10.1007/s00345-014-1376-4

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