Reproducibility and interobserver agreement of the R.E.N.A.L. nephrometry score: focus on imaging features

To investigate the reproducibility and interobserver agreement for R.E.N.A.L. nephrometry scoring system.

Two independent radiologists retrospectively analyzed 46 consecutive patients with renal masses, between 2008 and 2012, using the R. E.N.A.L. nephrometry score (RENAL-NS), which is based on the evaluation of five anatomical features of the tumor, as evaluated with computed tomography or magnetic resonance imaging: Radius, Exophytic/endophytic properties, Nearness to the collecting system, Anterior or posterior descriptor, and Location relative to the polar line. Tumor complexity was graded as low, intermediate, or high. The interobserver agreement was calculated for the total score and for the score for each parameter. Surgical excision of the tumors was used as the standard of reference.

The interobserver agreement for each of the RENAL-NS parameters, respectively, a hilar location, and the total score was 98%, 80%, 100%, 89%, 85%, 89%, and 93% of patients, corresponding to kappa values of 0.96, 0.65, 1.00, 0.75, 0.72, 0.78, and 0.88, respectively. The Nearness, Radius, and total score showed the best agreement. For the cases that were discordant in terms of the final score, no major implications in surgical planning were observed.

The RENAL-NS is a structured, useful system to assess the anatomical features of renal tumors. It is easily applicable and reproducible, even for less experienced radiologists.

Investigar a concordância interobservador e a reprodutibilidade do sistema de pontuação nefrométrico R.E.N.A.L. nephrometry score (RENAL-NS) usando imagens de tomografia computadorizada e ressonância magnética.

Dois observadores independentes analisaram, retrospectivamente, 46 pacientes com massas renais, consecutivos, de 2008 a 2012. Cinco características anatômicas foram avaliadas: raio (R); localização exofítico/endofítico (E); proximidade do tumor ao sistema coletor (N, nearness); posição anterior (A) ou posterior e de localização em relação à linha polar (L). Os tumores foram classificados em baixo, intermediário ou alto grau de complexidade. A concordância foi calculada para cada parâmetro do escore e para o valor global. A excisão cirúrgica das lesões foi utilizada como padrão de referência.

A concordância para cada um dos parâmetros renais, para a característica de "h", e para a pontuação final foi 98%, 80%, 100%, 89%, 85%, 89% e 93% dos pacientes, o que corresponde a valores de kappa de 0,96, 0,65, 1,00, 0,75, 0,72, 0,78 e 0,88, respectivamente. Os parâmetros "N", "R" e o escore global mostraram as melhores concordâncias. Entre os casos discordantes na pontuação final, não foram observadas grandes mudanças no planejamento cirúrgico.

O RENAL-NS é um sistema estruturado, útil para avaliar características anatômicas do tumor renal. É de fácil aplicação, reprodutível, mesmo entre os radiologistas menos experientes.

Radiologia brasileira. 0000 Jan [Epub]

Richard Mast Vilaseca, Antonio Carlos Westphalen, Henrique Ferreira Reis, Orlando Salomão Zogbi, Gyl Eanes Silva, Rodolfo Borges Dos Reis, Valdair Francisco Muglia

MD, Attending Radiologist, Radiology Department - Abdominal Imaging, Hospital Universitari Vall d'Hebron, Barcelona, Spain., MD, PhD, Associate Professor of Radiology, Radiology and Biomedical Engineering, University of California at San Francisco (UCSF), San Francisco, CA, USA., MD, Attending Radiologist, Internal Medicine Department - Imaging Division, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil., MD, PhD, Assistant Professor, Department of Pathology, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil., MD, PhD, Assistant Professor, Department of Surgery - Urology Division, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil., MD, PhD, Associate Professor, Department of Radiology, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil.

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