Original and reviewed nuclear grading according to the Fuhrman system

Abstract

BACKGROUNDThe objective of the current study was to evaluate the reproducibility of the Fuhrman nuclear grading system as well as its independent predictive value in a series of patients with conventional renal cell carcinoma (RCC).METHODSThe authors selected 388 patients who had undergone surgical treatment for conventional RCC between 1986 and 2000. Pathology slides from the selected patients were reviewed by a single pathologist, who reassigned a Fuhrman nuclear grade and assessed the presence of tumor necrosis. The pathologist was blinded to both the original pathologic diagnosis and follow‐up data. The κ statistic was used to evaluate concordance between original and reviewed nuclear grades. The log‐rank test was used for univariate analyses, and a Cox proportional hazards model was used for multivariate analyses.RESULTSThe original Fuhrman nuclear grade was Grade 1 (G1) in 111 patients (28.6%), G2 in 141 patients (36.3%), G3 in 108 patients (27.8%), and G4 in 28 patients (7.3%). After pathology slide review, nuclear grades were reassigned as follows: G1 in 49 patients (12.6%), G2 in 138 patients (35.6%), G3 in 150 patients (38.7%), and G4 in 51 patients (13.1%). The grade of concordance was moderate (κ = 0.44; P < 0.001). Univariate analyses identified three separate prognostic categories defined by nuclear grade (G1 and G2 vs. G3 vs. G4). Both the original and the reviewed Fuhrman nuclear grading systems were capable of independently predicting disease‐specific survival in patients with conventional RCC.CONCLUSIONSThe interobserver reproducibility of Fuhrman nuclear grading was moderate. The substantial overlap in survival curves for G1 and G2 tumors provided an opportunity to cluster those categories, and the resulting three‐tiered nuclear grading system was an independent predictor of cause‐specific survival in patients with conventional RCC. Other independent predictors of survival included pathologic stage and tumor necrosis status. Cancer 2005. © 2004 American Cancer Society.

Automated grading of renal cell carcinoma using whole slide imaging

“…However, this drawback is minimized because studies have shown that Grades I and II tumors have a similar prognosis and that there is limited benefit in distinguishing them. [20212235] Another limitation is that the maximum nuclear size in the slide cannot distinguish Grade III from Grade IV tumors. This limitation is expected since Grade IV is determined by the morphology of the nuclei, and not just their size.…”

“…We selected only three cases for Grade I because of its rarity (5-10%) among clear cell RCC cases. [102021]…”

“…[16171819] As a result, more simplified systems, such as two-tier and three-tier grading systems, have been proposed to achieve better concordance, while retaining comparable prognostic evaluation power. [202122] Despite of this improvement, the tedious task of determining Fuhrman nuclear grade may be better handled using more efficient, objective, and quantitative methods, such as automatic WSI analysis.…”

The ISUP system of staging, grading and classification of renal cell neoplasia

“…(16, 49–51). Despite this, the value of this system in assessment of prognosis has been questioned (17, 19). Several studies have found that the Fuhrman grading system has prognostic significance only when the data are grouped (e.g.…”

Clinical and Prognostic Value of the Presence of Irregular Giant Nuclear Cells in pT1 Ovarian Clear Cell Carcinoma

“…Subsequently, the prognostic value of the Fuhrman nuclear grading system has well been recognized. However, the interobserver reproducibility is not considered to be satisfactory because of the complexity of the four-tiered grading system [26][27][28]. In the present Fig.…”