BACKGROUND: The Fuhrman system is the most widely used nuclear grading system for renal cell carcinoma (RCC). Although Fuhrman nuclear grade is widely accepted as a significant prognostic factor, its reproducibility, as reported in the limited number of series available in the literature, appears to be low. METHODS: Between 1980 and 1990, 255 cases of RCC (pT1-3bN0M0) were treated with radical nephrectomy at the Department of Urology, University Hospital, Strasbourg, France. In a retrospective multicenter study, 3 pathologists independently classified 241 of these 255 cases according to the Fuhrman grading system. The authors searched for optimal interobserver agreement by collapsing the grading system to a three-tiered scheme and then to a two-tiered scheme. In addition, overall survival curves were generated according to the classic four-tiered scheme and also according to the best collapsed scheme. The kappa index was used to assess the level of agreement between each pair of observers, and the Cox model was used for multivariate survival analyses. RESULTS: The mean interobserver kappa value was 0.22 (range, 0.09-0.36). The best concordance was obtained by collapsing to a system in which low-grade (Grade 1-2) disease was compared with high-grade (Grade 3-4) disease. Doing so improved the mean interobserver kappa value to 0.44 (range, 0.32-0.55). Fuhrman grade was an independent prognostic factor for all 3 pathologists (P = 0.01, P < 0.0001, and P = 0.004, respectively), and nuclear grade continued to have independent prognostic value after the optimal collapsing algorithm was performed (P = 0.004, P = 0.0003, and P = 0.005). CONCLUSIONS: Collapsing of the Fuhrman grading system to a two-tiered scheme led to an improvement in interobserver agreement while preserving the independent prognostic value of nuclear grade. (c) 2004 American Cancer Society
BACKGROUND: The Fuhrman system is the most widely used nuclear grading system for renal cell carcinoma (RCC). Although Fuhrman nuclear grade is widely accepted as a significant prognostic factor, its reproducibility, as reported in the limited number of series available in the literature, appears to be low. METHODS: Between 1980 and 1990, 255 cases of RCC (pT1-3bN0M0) were treated with radical nephrectomy at the Department of Urology, University Hospital, Strasbourg, France. In a retrospective multicenter study, 3 pathologists independently classified 241 of these 255 cases according to the Fuhrman grading system. The authors searched for optimal interobserver agreement by collapsing the grading system to a three-tiered scheme and then to a two-tiered scheme. In addition, overall survival curves were generated according to the classic four-tiered scheme and also according to the best collapsed scheme. The kappa index was used to assess the level of agreement between each pair of observers, and the Cox model was used for multivariate survival analyses. RESULTS: The mean interobserver kappa value was 0.22 (range, 0.09-0.36). The best concordance was obtained by collapsing to a system in which low-grade (Grade 1-2) disease was compared with high-grade (Grade 3-4) disease. Doing so improved the mean interobserver kappa value to 0.44 (range, 0.32-0.55). Fuhrman grade was an independent prognostic factor for all 3 pathologists (P = 0.01, P < 0.0001, and P = 0.004, respectively), and nuclear grade continued to have independent prognostic value after the optimal collapsing algorithm was performed (P = 0.004, P = 0.0003, and P = 0.005). CONCLUSIONS: Collapsing of the Fuhrman grading system to a two-tiered scheme led to an improvement in interobserver agreement while preserving the independent prognostic value of nuclear grade. (c) 2004 American Cancer Society
Authors: Wassim Kassouf; Leonardo L Monteiro; Darrel E Drachenberg; Adrian S Fairey; Antonio Finelli; Anil Kapoor; Jean-Baptiste Lattouf; Michael J Leveridge; Nicholas E Power; Frederic Pouliot; Ricardo A Rendon; Robert Sabbagh; Alan I So; Simon Tanguay; Rodney H Breau Journal: Can Urol Assoc J Date: 2018-05-31 Impact factor: 1.862
Authors: Yulian Mytsyk; Yuriy Borys; Lesia Tumanovska; Dmytro Stroy; Askold Kucher; Katarina Gazdikova; Luis Rodrigo; Peter Kruzliak; Robert Prosecky; Peter Urdzik; Victor Dosenko Journal: Clin Exp Med Date: 2019-08-22 Impact factor: 3.984
Authors: Andrew B Rosenkrantz; Aarti Sekhar; Elizabeth M Genega; Jonathan Melamed; James S Babb; Amish D Patel; Andy Lo; Robert M Najarian; Muneeb Ahmed; Ivan Pedrosa Journal: Eur Radiol Date: 2012-08-21 Impact factor: 5.315
Authors: Hebert Alberto Vargas; Holly G Delaney; Eithne M Delappe; Ya Wang; Junting Zheng; Chaya S Moskowitz; Yongqiang Tan; Binsheng Zhao; Lawrence H Schwartz; Hedvig Hricak; Paul Russo; Oguz Akin Journal: J Magn Reson Imaging Date: 2012-11-13 Impact factor: 4.813
Authors: Attila Szendroi; Elek Dinya; Magdolna Kardos; A Marcel Szász; Zsuzsanna Németh; Katalin Ats; János Kiss; Imre Antal; Imre Romics; Miklós Szendroi Journal: Pathol Oncol Res Date: 2009-07-29 Impact factor: 3.201