title: [Reproducibility of Fuhrman nuclear grade: advantages of a two-grade system].
abstract: The Fuhrman nuclear grade is the reference histoprognostic grading system routinely used all over the world for renal cell carcinoma. Studies measuring the inter-observer and intra-observer concordance of Fuhrman grade show poor results in terms of reproducibility and repeatability. These variations are due to a certain degree of subjectivity of the pathologist in application of the definition of tumour grade, particularly nuclear grade. Elements able to account for this subjectivity in renal cell carcinoma are identified from a review of the literature. To improve the reliability of nuclear grade, the territory occupied by the highest grade must be specified and the grades should probably be combined. At the present time, regrouping of grade 1 and 2 tumours as low grade and grade 3 and 4 tumours as high grade would achieve better reproducibility, while preserving the prognostic: value for overall survival. The development of new treatment modalities and their use in adjuvant situations will imply the use of reliable histoprognostic factors to specify, indications.
authors.affiliation: Service d'Urologie, Hôpital Civil, CHU de Strashourg, France. herve.letourneux@chru-strasbourg.fr
authors.forename: Hervé
authors.initials: H
authors.lastname: Letourneux
authors.forename: Véronique
authors.initials: V
authors.lastname: Lindner
authors.forename: Hervé
authors.initials: H
authors.lastname: Lang
authors.forename: Thierry
authors.initials: T
authors.lastname: Massfelder
authors.forename: Nicolas
authors.initials: N
authors.lastname: Meyer
authors.forename: Christian
authors.initials: C
authors.lastname: Saussine
authors.forename: Didier
authors.initials: D
authors.lastname: Jacqmin
mesh_terms: D002292:Carcinoma, Renal Cell / Q000473:pathology*; D003950:Diagnostic Techniques, Urological; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology*; D015203:Reproducibility of Results