Comparing World Health Organization/International Society of Urological Pathology Grading and Fuhrman Grading with the Prognostic Value of Nuclear Area in Patients with Renal Cell Carcinoma

Abstract

This study was undertaken to compare Fuhrman grading with World Health Organization/International Society of Urological Pathology (WHO/ISUP) grading and stereologically measured nuclear area in patients with Clear Cell Renal Cell Carcinoma (ccRCC) or Papillary Renal Cell Carcinoma (PRCC) and to evaluate the independent predictive value of Fuhrman, WHO/ISUP and stereologically measured nuclear area combined with necrosis in a series of patients with ccRCC in relation to cancer-specific survival. In all, 124 cases of ccRCC and PRCC were included. All slides were blindly scored by two trained pathologists according to the Fuhrman and WHO/ISUP grading systems. Nuclear measurements were performed on digitally scanned slides in Visiopharm® and correlated to survival. Analysis of ccRCC and PRCC cases showed that application of WHO/ISUP grading resulted in a significant downgrading of cases from G2 to G1, when comparing with Fuhrman grading. Neither of these patients experienced progression. Cancer specific survival estimates in 101 ccRCC patients showed that WHO/ISUP grading was slightly superior in predicting cancer-specific survival. Novel models included WHO/ISUP grading and mean nuclear area (MNA) each of which combined with necrosis. Both demonstrated an increased ability to predict cancer-specific survival. The study demonstrates that WHO/ISUP grading provides superior prognostic information compared to Fuhrman grading and stereologically measured nuclear area. Necrosis in combination with either WHO/ISUP grading or MNA adds additional prognostic information.

Urine cytology in the detection of renal cell carcinomas – a territory‐wide multi‐institutional retrospective review of more than 2 decades

“…The nuclear grades I to III are relatively interchangeable between these two systems. 27 The grade IV in the Fuhrman system, whereas the ISUP-WHO grading system includes rhabdoid and sarcomatous tumor cells in the grade IV category. 27 These types of tumor cells were analyzed separately from nuclear grading, and the presence of sarcomatoid tumor cells was found to independently correlate with a diagnosis of atypia or above.…”

Prognostic value of nuclear morphometry in myxoid liposarcoma

“…The original Fuhrman and WHO/ISUP grading systems represent methods that assess the nuclear morphology in renal cell carcinoma to predict prognosis. 4 , 17 , 18 The present study used the modified versions as shown in Table 1 . The highest grade in the specimen was adopted in either grading system, as in the original ones.…”

“…These characteristics are often used to distinguish between benign and malignant tumors and to predict prognosis in many malignancies. 1 , 2 , 3 , 4 …”

Histologic re‑evaluation of a population‑based series of renal cell carcinomas from The Netherlands Cohort Study according to the 2022 ISUP/WHO classification

“…In contrast, the ISUP grading system relies only on the size of the nucleolus for grading tumors 1-3 and on the presence of giant cells or, the presence of sarcomatoid differentiation or RD features for assigning grade 4 (18,29). Previously, several studies compared Furman grading with WHO/ISUP grading (55,56). In these studies, the WHO/ISUP grading was shown to provide superior prognostic information compared to Fuhrman grading (55,56).…”

“…Previously, several studies compared Furman grading with WHO/ISUP grading (55,56). In these studies, the WHO/ISUP grading was shown to provide superior prognostic information compared to Fuhrman grading (55,56). Therefore, the regrading of the kidney tumors in the research databases could be a reasonable procedure.…”