Clear cell renal cell carcinoma: validation of World Health Organization/International Society of Urological Pathology grading

Dagher, Julien; Delahunt, Brett; Rioux‐Leclercq, Nathalie; Egevad, Lars; Srigley, John R.; Coughlin, Geoffrey; Dunglinson, Nigel; Gianduzzo, Troy; Kua, Boon; Malone, Greg; Martin, Ben; Preston, John; Pokorny, Morgan; Wood, Simon; Yaxley, John; Samaratunga, Hemamali

doi:10.1111/his.13311

Cited by 109 publications

(97 citation statements)

References 23 publications

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“…The WHO/ISUP grading system outlined in the 2016 WHO Classification of Tumours of the Urinary System and Male Genital Organs encompasses these guidelines . The WHO/ISUP grading system has been validated in the literature to show a statistically significant difference in cancer‐free survival between grades 2 versus 3 and between grades 3 versus 4 (grade 1 excluded from analysis because no tumors had recurrence/metastases) …”

Section: Discussionmentioning

confidence: 99%

World Health Organization (WHO)/International Society of Urological Pathology (ISUP) grading in fine‐needle aspiration biopsies of renal masses

Perrino

Cramer

Chen

et al. 2018

Diagnostic Cytopathology

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Background Utilization of fine‐needle aspiration (FNA) biopsy for the evaluation of renal masses has been increasing at our institution. At times diagnostic material on direct smears is superior to that in the cell block/core biopsy, therefore assigning an accurate nuclear grade in the cytopathology report would provide useful prognostic information. Methods Search of the pathology database identified renal FNAs performed during an 11‐year period (2006–2017). Corresponding core biopsies and resections were identified. Cases with a diagnosis of primary renal neoplasia on FNA, core biopsy, and/or resection were included. Two pathologists reviewed all cases and assigned a World Health Organization (WHO)/International Society of Urological Pathology (ISUP) grade to each FNA, core biopsy, and resection case. Results A total of 162 kidney FNAs were identified. Primary renal neoplasia was diagnosed in 137 cases on core biopsy/resection. Among diagnostic FNAs of clear cell RCC and papillary RCC with core biopsy/resection specimens for re‐review (n = 52), reviewers assigned a concordant WHO/ISUP grade to 83% (43/52) of cases. Among 9 cases with discrepant scores, all had a discrepancy of 1 grade and were undergraded on FNA. Using a two tier grading system (low vs. high grade), reviewers assigned a concordant grade to 88% (46/52) of cases. Among 6 cases with discrepant scores, all were classified as low grade (WHO/ISUP grade 2) on FNA versus high grade (WHO/ISUP grade 3) on resection. Conclusion The WHO/ISUP grade assigned on FNA shows good concordance with subsequent resection/core specimens (83%), with all discrepant cases being undergraded by one grade.

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Section: Discussionmentioning

confidence: 99%

World Health Organization (WHO)/International Society of Urological Pathology (ISUP) grading in fine‐needle aspiration biopsies of renal masses

Perrino

Cramer

Chen

et al. 2018

Diagnostic Cytopathology

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“…In those cases where there is discordance between grading parameters there is no advice available regarding the weighting of grading criteria, and as a consequence Fuhrman grading cannot be applied. This issue has been investigated recently and it was shown that in a series of clear cell RCC there was discordance of grading criteria in 21.1% of cases, which means in effect that more than one‐fifth of clear cell RCCs cannot be graded using Fuhrman criteria . A further criticism relates to the criteria defined in the Fuhrman system.…”

Section: Nuclear Grading Of Renal Cell Carcinomamentioning

confidence: 99%

“…It should be noted that this component of WHO/ISUP grading is not simply a reflection of the nucleolar size component of Fuhrman grading, as more prominent nucleoli are acceptable in both grades 1 and 2. This has resulted in an observed down‐grading of cases when WHO/ISUP grading is compared to those cases where Fuhrman grading is possible . A further difference was incorporated into the fourth edition of the WHO Bluebook on malignancies of the urinary tract, where the criteria were slightly modified to emphasise that grade 2 nucleoli should appear eosinophilic …”

Section: Who/isup Gradingmentioning

confidence: 99%

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Grading of renal cell carcinoma

Delahunt¹,

et al. 2018

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Grading of renal cell carcinoma (RCC) has been recognised as a prognostic factor for almost 100 years. Numerous grading systems have been proposed, initially focusing upon a constellation of cytological features and more recently on nuclear morphology. It has been recommended that grading of RCC should be based upon nucleolar prominence/eosinophilia for grades 1–3, while grade 4 requires nuclear anaplasia (including tumour giant cells, sarcomatoid differentiation and/or rhabdoid morphology). The grading system was adopted formally by the International Society of Urological Pathology (ISUP) and subsequently by the World Health Organisation (WHO), being designated the WHO/ISUP grading classification in the fourth edition of the WHO classification tumours of the urinary system and male genital organs (2016). This grading system has been validated for both clear cell and papillary RCC. Validation studies for chromophobe RCC failed to demonstrate a correlation between grade and outcome for both the superseded Fuhrman grading system and the WHO/ISUP grading classification, and it has been recommended that these tumours not be graded. The WHO/ISUP system has been incorporated into the structured reports of the International Cancer Collaboration on Cancer Reporting for both clear cell and papillary RCC. It is also noted that other types of RCC may be graded, but it must be emphasised in the report that this is for descriptive and diagnostic purposes, and not outcome prediction. More recent studies have shown the incorporation of the presence of tumour necrosis into RCC grading to improve outcome prediction, and this has been validated in several studies.

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“…This grading system was adopted by the 2012 Vancouver Consensus Conference on Renal Neoplasia and was endorsed by the WHO, being included in the fourth edition of the Bluebook classification of renal tumours . This system has been validated as a prognostic parameter for clear cell and papillary RCC . The current recommendation is that chromophobe RCC is not graded .…”

Section: Resultsmentioning

confidence: 99%

Data set for the reporting of carcinoma of renal tubular origin: recommendations from the International Collaboration on Cancer Reporting (ICCR)

et al. 2019

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Aims The International Collaboration on Cancer Reporting (ICCR) has provided detailed data sets based upon the published reporting protocols of the Royal College of Pathologists, the Royal College of Pathologists of Australasia and the College of American Pathologists. Methods and results The data set for carcinomas of renal tubular origin treated by nephrectomy was developed to provide a minimum structured reporting template suitable for international use, and incorporated recommendations from the 2012 Vancouver Consensus Conference of the International Society of Urological Pathology (ISUP) and the fourth edition of the World Health Organisation Bluebook on tumours of the urinary and male genital systems published in 2016. Reporting elements were divided into those, which are required and recommended components of the report. Required elements are: specimen laterality, operative procedure, attached structures, tumour focality, tumour dimension, tumour type, WHO/ISUP grade, sarcomatoid/rhabdoid morphology, tumour necrosis, extent of invasion, lymph node status, surgical margin status, AJCC TNM staging and co‐existing pathology. Recommended reporting elements are: pre‐operative treatment, details of tissue removed for experimental purposes prior to submission, site of tumour(s) block identification key, extent of sarcomatoid and/or rhabdoid component, extent of necrosis, presence of tumour in renal vein wall, lymphovascular invasion and lymph node status (size of largest focus and extranodal extension). Conclusions It is anticipated that the implementation of this data set in routine clinical practice will inform patient treatment as well as provide standardised information relating to outcome prediction. The harmonisation of data reporting should also facilitate international research collaborations.

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Clear cell renal cell carcinoma: validation of World Health Organization/International Society of Urological Pathology grading

Abstract: The study demonstrates that FG cannot be applied in >20% of cases of ccRCC and the WHO/ISUP provides superior prognostic information.

Cited by 109 publications

References 23 publications

World Health Organization (WHO)/International Society of Urological Pathology (ISUP) grading in fine‐needle aspiration biopsies of renal masses

World Health Organization (WHO)/International Society of Urological Pathology (ISUP) grading in fine‐needle aspiration biopsies of renal masses

Grading of renal cell carcinoma

Data set for the reporting of carcinoma of renal tubular origin: recommendations from the International Collaboration on Cancer Reporting (ICCR)

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