Reproducibility and Fidelity of the R.E.N.A.L. Nephrometry Score

Montag, Sylvia; Waingankar, Nikhil; Sadek, M. A.; Rais‐Bahrami, Soroush; Kavoussi, Louis R.; Vira, Manish

doi:10.1089/end.2011.0217

Cited by 35 publications

(31 citation statements)

References 22 publications

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“…In our cohort of patients the mathematical model C-Index, which is a measure of tumor centrality, showed the highest level of agreement amongst readers and appeared to be the least prone to subjectivity of the three systems. Consistent with this finding and those of prior studies [9,14,15], the analysis of the IOV of each system's individual components showed that the (R)adius and the (A)nterior/posterior subscales of the R.E.N.A.L. system and tumor size in the PADUA system had the highest concordance rates amongst readers while the (L)ocation relative to polar lines (R.E.N.A.L.)…”

Section: Discussionsupporting

confidence: 93%

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

et al. 2014

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Purpose To assess interobserver variability of R.E.N.A.L., PADUA, and 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 1 radiology fellow, 2 urology fellows, 1 radiology resident, and 1 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 eGFR were evaluated using Spearman 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, 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.

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Section: Discussionsupporting

confidence: 93%

“…Good concordance and kappa values amongst readers were also found in studies on IOV of the R.EN.A.L. system used for open or laparoscopic PN patients, respectively [14,15]. In these studies, however, scores were assigned by small groups of urologists at different stages of professional development but with similar urological training.…”

Section: Discussionmentioning

confidence: 96%

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

et al. 2014

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“…nephrometry has been shown to be user-friendly and reproducible with a high degree of interobserver reliability. 12,20 Limitations of the scoring system were highlighted by Kutikov and Uzzo, including the impossibility of reaching the maximum score of 12 and the fact that the difference between each unit of scoring does not represent equal quanta of surgical complexity. 8 One item that can be improved is the incorporation of hilar tumors into the scoring system as opposed to simply using it as a suffix.…”

Section: Discussionmentioning

confidence: 99%

R.E.N.A.L. Nephrometry Score Accurately Predicts Complications Following Laparoscopic Renal Cryoablation

et al. 2012

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“…Interobserver correlation is high, rendering it a high fidelity assessment tool. 12 Similar to Canter et al, other groups have shown that RENAL NS predicted surgeon preference for selection of RN versus PN in retrospective analyses. 13 Other standardized scoring systems include the preoperative aspects and dimensions used for anatomic (PADUA) classification and centrality (c)-index scores.…”

mentioning

confidence: 61%

“…Median operating time was 270 minutes, and median blood loss was 150 mL. Median WIT was 20 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29) minutes and median hospital stay was 3 days. One patient developed postoperative hemorrhage and pulmonary embolism.…”

Section: Less/notes Pnmentioning

confidence: 99%

Laparoscopic partial nephrectomy: state of the art review

Faiena¹,

Han²,

Olweny³

2014

OAS

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Introduction:The surgical management of small renal masses (,4 cm) has greatly evolved over the last few decades, with the paradigm shifting from radical to partial nephrectomy. Laparoscopic partial nephrectomy (LPN) is increasingly utilized, and has achieved similar outcomes to open partial nephrectomy with decreased patient morbidity in experienced hands. The aim of this review was to examine the current status and future direction of LPN. Materials and methods:We performed a nonsystematic review of the literature using a free-text protocol in the PubMed database, using the terms "laparoscopic partial nephrectomy", "robotassisted partial nephrectomy", "robotic partial nephrectomy", and "laparoscopic partial nephrectomy oncologic and functional outcomes". Only English language articles were selected. Evidence synthesis: Our search results yielded 1,136. Three authors reviewed the results, and articles with information on patient and tumor selection, surgical techniques, and oncologic and functional outcomes were included. With regard to outcomes, only series with the largest cohorts and longest follow-up were selected. Conclusion: LPN has evolved rapidly over the past 2 decades, and advances in technique as well as innovations in surgical technologies have facilitated its increased adoption in urologic practice. However, limitations remain, such as inadequacy of techniques to achieve cold ischemia laparoscopically, high technical demands of intracorporeal suturing, and limited ability to assess surgical anatomy beyond the field of view. These comprise goals of research aimed at improving future surgical precision and outcomes, while further decreasing the invasiveness of LPN.

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Reproducibility and Fidelity of the R.E.N.A.L. Nephrometry Score

Abstract: The R.E.N.A.L. NS system is a comprehensive and reproducible tool that may aid surgeons in communicating tumor characteristics effectively. Interobserver correlation is high, rendering it a high fidelity assessment tool.

Cited by 35 publications

References 22 publications

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

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

R.E.N.A.L. Nephrometry Score Accurately Predicts Complications Following Laparoscopic Renal Cryoablation

Laparoscopic partial nephrectomy: state of the art review

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