Interobserver variability of R.E.N.A.L., PADUA, and centrality index nephrometry score systems View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2014-08-24

AUTHORS

Massimiliano Spaliviero, Bing Ying Poon, Omer Aras, Pier Luigi Di Paolo, Giuliano B. Guglielmetti, Christian Z. Coleman, Christoph A. Karlo, Melanie L. Bernstein, Daniel D. Sjoberg, Paul Russo, Karim A. Touijer, Oguz Akin, Jonathan A. Coleman

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.MethodsComputed 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.ResultsAgreement 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.ConclusionsClinical 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. More... »

PAGES

853-858

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00345-014-1376-4

DOI

http://dx.doi.org/10.1007/s00345-014-1376-4

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1034915671

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/25149471


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30 schema:description 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.MethodsComputed 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.ResultsAgreement 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.ConclusionsClinical 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.
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37 schema:keywords ConclusionsClinical experience
38 EGFR
39 MethodsComputed tomography (CT) images
40 Padua
41 R.E.N.A.
42 R.E.N.A.L.
43 ResultsAgreement
44 Spearman correlation
45 agreement
46 anatomic variables
47 anatomical classification system
48 aspects
49 association
50 centrality index (C-Index) systems
51 centrality index nephrometry score systems
52 changes
53 classification system
54 clinical experience
55 coefficient
56 correlation
57 correlation coefficient
58 degree
59 differences
60 dimensions
61 distance
62 experience
63 fellow scores
64 fellows
65 filtration rate
66 glomerular filtration rate
67 images
68 index
69 index method
70 index nephrometry score systems
71 index system
72 interobserver variability
73 intraclass correlation coefficient
74 intrarenal structures
75 involvement
76 ischemia time
77 laparoscopic partial nephrectomy
78 lines
79 location
80 measureable anatomic variables
81 measures
82 method
83 metrics
84 nearness
85 nephrectomy
86 nephrometry score systems
87 nephrometry system
88 observer
89 outcome metrics
90 outcomes
91 partial nephrectomy
92 patients
93 percent change
94 physicians
95 polar line
96 postoperative eGFR
97 preoperative aspects
98 purpose
99 radiology fellow scores
100 radiology fellows
101 radiology residents
102 rate
103 readers
104 reference
105 reference scores
106 relevant outcomes
107 renal sinus involvement
108 residents
109 robot-assisted laparoscopic partial nephrectomy
110 school students
111 score system
112 scores
113 secondary school students
114 sinus
115 sinus involvement
116 size
117 structure
118 students
119 subscale correlations
120 subscales
121 surgical outcome metrics
122 system
123 system involvement
124 time
125 tomography images
126 tumor size
127 urology fellows
128 variability
129 variables
130 weeks
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