title: Interobserver variability of R.E.N.A.L., PADUA, and centrality index nephrometry score systems.
abstract: OBJECTIVE
  To assess interobserver variability of R.E.N.A.L., preoperative aspects and dimensions used for an anatomical classification system (PADUA), and centrality index (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 one radiology fellow, two urology fellows, one radiology resident, and one 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 estimated glomerular filtration rate (eGFR) were evaluated using Spearman's 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, and 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.
authors.affiliation: Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Spaliviero
authors.forename: Bing Ying
authors.initials: BY
authors.lastname: Poon
authors.forename: Omer
authors.initials: O
authors.lastname: Aras
authors.forename: Pier Luigi
authors.initials: PL
authors.lastname: Di Paolo
authors.forename: Giuliano B
authors.initials: GB
authors.lastname: Guglielmetti
authors.forename: Christian Z
authors.initials: CZ
authors.lastname: Coleman
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Karlo
authors.forename: Melanie L
authors.initials: ML
authors.lastname: Bernstein
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Sjoberg
authors.forename: Paul
authors.initials: P
authors.lastname: Russo
authors.forename: Karim A
authors.initials: KA
authors.lastname: Touijer
authors.forename: Oguz
authors.initials: O
authors.lastname: Akin
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Coleman
mesh_terms: D000368:Aged; D000886:Anthropometry; D002292:Carcinoma, Renal Cell / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D015331:Cohort Studies; D005257:Fellowships and Scholarships; D005260:Female; D006801:Humans; D007396:Internship and Residency; D007668:Kidney / Q000000981:diagnostic imaging*; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D015588:Observer Variation; D017063:Outcome Assessment, Health Care; D011871:Radiology / Q000193:education*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D012574:Schools; D013334:Students; D014057:Tomography, X-Ray Computed; D047368:Tumor Burden; D014572:Urology / Q000193:education*