Nephrometry scores quantify renal tumor complexity to standardize reporting, however, manual calculation is time-consuming and prone to interobserver variability. Furthermore, 2-dimensional preoperative imaging limits anatomical interpretation. Therefore, we developed a fully automated method using 3-dimensional (3D) models to calculate 4 established scoring systems: RENAL, PADUA, C-index and CSA, and benchmarked them against manual calculations for validation.
Preoperative CT scans and manually segmented 3D models of 80 patients undergoing robot-assisted partial nephrectomy at Ghent University Hospital were analyzed. 3 observers (student, resident, expert) manually scored each CT.Automated 3D scores were generated using our Python-based algorithm. Discrepant resident-expert scores were re-evaluated to reach consensus for comparison with automatic scores. Interobserver variability was assessed using intraclass correlation coefficients (ICC). Scoring durations were compared using paired t-tests. Pearson correlation coefficients were calculated between automated/manual scores and surgical complexity metrics: estimated blood loss (EBL), operative time (OT), and warm ischemic time (WIT).
Manual interobserver agreement was moderate to good (ICC(2,1) = 0.72-0.90). Re-evaluation was needed in 67 cases (83.75%). Automated scores demonstrated moderate to good agreement with manual consensus (ICC(3,1) = 0.68-0.89) and substantially reduced scoring time (manual = 5.9 minutes vs. automated = 0.2 minutes; p < 0.001). Expert re-evaluation confirmed automated accuracy in 92.9% of reviewed cases. Correlations with EBL, OT, and WIT did not differ significantly between manual and automated methods (p > 0.1).
Our fully automated 3D model-based calculations of RENAL, PADUA, C-index, and CSA offer improved reproducibility, accuracy and efficiency while maintaining clinical validity.
Urologic oncology. 2026 Apr 18 [Epub ahead of print]
Saar Vermijs, Joris Vangeneugden, Lara Demeyere, Marthe Termote, Pieter De Visschere, Pieter De Backer, Camille Berquin, Karel Decaestecker, Charlotte Debbaut, Charles Van Praet
IBiTech-BioMMedA, Department of Electronics and Information Systems, Faculty of Engineering and Architecture, Ghent University, Ghent, Belgium; Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Cancer Research Institute Ghent, Ghent University, Ghent, Belgium. Electronic address: ., Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Cancer Research Institute Ghent, Ghent University, Ghent, Belgium; Department of Urology, ERN eUROGEN accredited center, Ghent University Hospital, Ghent, Belgium., IBiTech-BioMMedA, Department of Electronics and Information Systems, Faculty of Engineering and Architecture, Ghent University, Ghent, Belgium., Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium., Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium., ORSI Academy, Melle, Belgium., Department of Urology, ERN eUROGEN accredited center, Ghent University Hospital, Ghent, Belgium., Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of Urology, ERN eUROGEN accredited center, Ghent University Hospital, Ghent, Belgium; Department of Urology, AZ Maria Middelares Hospital, Ghent, Belgium., IBiTech-BioMMedA, Department of Electronics and Information Systems, Faculty of Engineering and Architecture, Ghent University, Ghent, Belgium; Cancer Research Institute Ghent, Ghent University, Ghent, Belgium.