Interobserver variability of RENAL, PADUA, and centrality index nephrometry score systems Journal Article


Authors: Spaliviero, M.; Poon, B. Y.; Aras, O.; Di Paolo, P. L.; Guglielmetti, G. B.; Coleman, C. Z.; Karlo, C. A.; Bernstein, M. L.; Sjoberg, D. D.; Russo, P.; Touijer, K. A.; Akin, O.; Coleman, J. A.
Article Title: Interobserver variability of RENAL, PADUA, and centrality index nephrometry score systems
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. © 2014, Springer-Verlag Berlin Heidelberg.
Keywords: outcome assessment; kidney neoplasms; partial nephrectomy; observer variability; nephrometry
Journal Title: World Journal of Urology
Volume: 33
Issue: 6
ISSN: 0724-4983
Publisher: Springer  
Date Published: 2015-06-01
Start Page: 853
End Page: 858
Language: English
DOI: 10.1007/s00345-014-1376-4
PROVIDER: scopus
PUBMED: 25149471
PMCID: PMC4556097
DOI/URL:
Notes: Export Date: 2 September 2015 -- Source: Scopus
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MSK Authors
  1. Jonathan Coleman
    233 Coleman
  2. Paul Russo
    505 Russo
  3. Abdelkrim Karim Touijer
    213 Touijer
  4. Daniel D. Sjoberg
    171 Sjoberg
  5. Oguz Akin
    213 Akin
  6. Christoph Alexander Karlo
    18 Karlo
  7. Omer Aras
    35 Aras
  8. Jessica Bing Ying Poon
    15 Poon