Abstract
Background
The RENAL nephrometry score (RNS) allows description of the anatomy and the complexity of renal masses. This study aimed to investigate the interobserver reproducibility of the RNS between a radiologist and a urologist.
Methods
The computed tomography (CT) scans of patients undergoing partial nephrectomy in the authors’ department between June 2010 and June 2013 were analyzed for determination of the RNS by a urologist and a radiologist blinded to the medical records. Cohen’s kappa coefficient was used for interobserver reproducibility assessment. Correlations with per- and postoperative complication rates and renal function were assessed.
Results
The study included 52 consecutive patients with a mean age of 55 years. The average score was 7.4 ± 1.7 for the urologist and 7.3 ± 1.5 for the radiologist. The Cohen’s kappa was 0.81 for R, 0.47 for E, 0.63 for N, 0.28 for A, and 0.21 for L. The Pearson’s coefficient for the total RNS was 0.70. The operative time and the occurrence of major complications were significantly correlated with the complexity assessed by the score of both observers. In the univariate analysis, the RNS, the American Society of Anesthesiologists score, and the patient’s age were significantly associated with major complication rates. In the multivariate analysis, the RNS remained significantly associated with major complications. No significant difference in postoperative renal function according to complexity group was found by either the urologist or the radiologist.
Conclusions
The reproducibility of the RNS between the radiologist and the urologist was not very good, especially for some items referring to the location of the tumor, although the major complication rates were significantly associated with the RNS for both observers.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Jayson M, Sanders H. Increased incidence of serendipitously discovered renal cell carcinoma. Urology. 1998;51:203–5.
Gupta K, Miller JD, Li JZ, Russell MW, Charbonneau C. Epidemiologic and socioeconomic burden of metastatic renal cell carcinoma (mRCC): a literature review. Cancer Treat Rev. 2008;34:193–205.
Go AS, Chertow GM, Fan D, McCulloch CE, Hsu C. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351:1296–305.
Novick AC. Nephron-sparing surgery for renal cell carcinoma. Annu Rev Med. 2002;53:393–407.
Ljungberg B, Cowan NC, Hanbury DC, et al. EAU guidelines on renal cell carcinoma: the 2010 update. Eur Urol. 2010;58:398–406.
Leibovich BC, Blute ML, Cheville JC, Lohse CM, Weaver AL, Zincke H. Nephron-sparing surgery for appropriately selected renal cell carcinoma between 4 and 7 cm results in outcome similar to radical nephrectomy. J Urol. 2004;171:1066–70.
Patard J-J, Shvarts O, Lam JS, et al. Safety and efficacity of partial nephrectomy for all T1 tumors based on an international multicenter experience. J Urol. 2004;171:2181–5.
Huang WC, Elkin EB, Levey AS, Jang TL, Russo P. Partial nephrectomy versus radical nephrectomy in patients with small renal tumors: is there a difference in mortality and cardiovascular outcomes? J Urol. 2009;181:55–61; discussion 61–2.
Patard J-J, Pantuck AJ, Crepel M, et al. Morbidity and clinical outcome of nephron-sparing surgery in relation to tumour size and indication. Eur Urol. 2007;52:148–54.
Sisul DM, Liss MA, Palazzi KL, et al. RENAL nephrometry score is associated with complications after renal cryoablation: a multicenter analysis. Urology. 2013;81:775–80.
Reyes J, Canter D, Putnam S, et al. Thermal ablation of the small renal mass: case selection using the RENAL nephrometry score. Urol Oncol. 2013;31:1292–7.
Kolla SB, Spiess PE, Sexton WJ. Interobserver reliability of the RENAL nephrometry scoring system. Urology. 2011;78:592–4.
Montag S, Waingankar N, Sadek MA, Rais-Bahrami S, Kavoussi LR, Vira MA. Reproducibility and fidelity of the RENAL nephrometry score. J Endourol. 2011;25:1925–8.
Owens WD, Felts JA, Spitznagel EL Jr. ASA physical status classifications: a study of consistency of ratings. Anesthesiology. 1978;49:239–43.
Kutikov A, Uzzo RG. The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location, and depth. J Urol. 2009;182:844–53.
Campbell SC, Novick AC, Belldegrun A, et al. Guideline for management of the clinical T1 renal mass. J Urol. 2009;182:1271–9.
Donat SM, Diaz M, Bishoff JT, et al. Follow-up for clinically localized renal neoplasms: AUA Guideline. J Urol. 2013;190:407–16.
Okhunov Z, Rais-Bahrami S, George AK, et al. The comparison of three renal tumor scoring systems: C-Index, P.A.D.U.A., and R.E.N.A.L. nephrometry scores. J Endourol. 2011;25:1921–4.
Ficarra V, Novara G, Secco S, et al. Preoperative aspects and dimensions used for an anatomical (PADUA) classification of renal tumours in patients who are candidates for nephron-sparing surgery. Eur Urol. 2009;56:786–93.
Rosevear HM, Gellhaus PT, Lightfoot AJ, Kresowik TP, Joudi FN, Tracy CR. Utility of the RENAL nephrometry scoring system in the real world: predicting surgeon operative preference and complication risk. BJU Int. 2012;109:700–5.
Simhan J, Smaldone MC, Tsai KJ, et al. Perioperative outcomes of robotic and open partial nephrectomy for moderately and highly complex renal lesions. J Urol. 2012;187:2000–4.
Liu Z-W, Olweny EO, Yin G, et al. Prediction of perioperative outcomes following minimally invasive partial nephrectomy: role of the R.E.N.A.L nephrometry score. World J Urol. 2013;31:1183–9.
Tanagho YS, Kaouk JH, Allaf ME, et al. Perioperative complications of robot-assisted partial nephrectomy: analysis of 886 patients at 5 United States centers. Urology. 2013;81:573–80.
Hew MN, Baseskioglu B, Barwari K, et al. Critical appraisal of the PADUA classification and assessment of the R.E.N.A.L. nephrometry score in patients undergoing partial nephrectomy. J Urol. 2011;186:42–6.
Hayn MH, Schwaab T, Underwood W, Kim HL. RENAL nephrometry score predicts surgical outcomes of laparoscopic partial nephrectomy. BJU Int. 2011;108:876–81.
Kruck S, Anastasiadis AG, Walcher U, Stenzl A, Herrmann TRW, Nagele U. Laparoscopic partial nephrectomy: risk stratification according to patient and tumor characteristics. World J Urol. 2012;30:639–46.
Zhang Z-Y, Tang Q, Li X-S, et al. Clinical analysis of the PADUA and the RENAL scoring systems for renal neoplasms: a retrospective study of 245 patients undergoing laparoscopic partial nephrectomy. Int J Urol. 2014;21:40–4.
Lavallee LT, Desantis D, Kamal F, et al. The association between renal tumour scoring systems and ischemia time during open partial nephrectomy. Can Urol Assoc J. 2013;7:E207–14.
Disclosures
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Benadiba, S., Verin, AL., Pignot, G. et al. Are Urologists and Radiologists Equally Effective in Determining the RENAL Nephrometry Score?. Ann Surg Oncol 22, 1618–1624 (2015). https://doi.org/10.1245/s10434-014-4152-1
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-014-4152-1