Reproducibility and interobserver agreement of the R.E.N.A.L. nephrometry score: focus on imaging features.

OBJECTIVE: To investigate the reproducibility and interobserver agreement for R.E.N.A.L. nephrometry scoring system. MATERIALS AND METHODS: Two independent radiologists retrospectively analyzed 46 consecutive patients with renal masses, between 2008 and 2012, using the R.E.N.A.L. nephrometry score (RENAL-NS), which is based on the evaluation of five anatomical features of the tumor, as evaluated with computed tomography or magnetic resonance imaging: Radius, Exophytic/endophytic properties, Nearness to the collecting system, Anterior or posterior descriptor, and Location relative to the polar line. Tumor complexity was graded as low, intermediate, or high. The interobserver agreement was calculated for the total score and for the score for each parameter. Surgical excision of the tumors was used as the standard of reference. RESULTS: The interobserver agreement for each of the RENAL-NS parameters, respectively, a hilar location, and the total score was 98%, 80%, 100%, 89%, 85%, 89%, and 93% of patients, corresponding to kappa values of 0.96, 0.65, 1.00, 0.75, 0.72, 0.78, and 0.88, respectively. The Nearness, Radius, and total score showed the best agreement. For the cases that were discordant in terms of the final score, no major implications in surgical planning were observed. CONCLUSION: The RENAL-NS is a structured, useful system to assess the anatomical features of renal tumors. It is easily applicable and reproducible, even for less experienced radiologists.

OBJETIVO: Investigar a concordância interobservador e a reprodutibilidade do sistema de pontuação nefrométrico R.E.N.A.L. nephrometry score (RENAL-NS) usando imagens de tomografia computadorizada e ressonância magnética. MATERIAIS E MÉTODOS: Dois observadores independentes analisaram, retrospectivamente, 46 pacientes com massas renais, consecutivos, de 2008 a 2012. Cinco características anatômicas foram avaliadas: raio (R); localização exofítico/endofítico (E); proximidade do tumor ao sistema coletor (N, nearness); posição anterior (A) ou posterior e de localização em relação à linha polar (L). Os tumores foram classificados em baixo, intermediário ou alto grau de complexidade. A concordância foi calculada para cada parâmetro do escore e para o valor global. A excisão cirúrgica das lesões foi utilizada como padrão de referência. RESULTADOS: A concordância para cada um dos parâmetros renais, para a característica de "h", e para a pontuação final foi 98%, 80%, 100%, 89%, 85%, 89% e 93% dos pacientes, o que corresponde a valores de kappa de 0,96, 0,65, 1,00, 0,75, 0,72, 0,78 e 0,88, respectivamente. Os parâmetros "N", "R" e o escore global mostraram as melhores concordâncias. Entre os casos discordantes na pontuação final, não foram observadas grandes mudanças no planejamento cirúrgico. CONCLUSÃO: O RENAL-NS é um sistema estruturado, útil para avaliar características anatômicas do tumor renal. É de fácil aplicação, reprodutível, mesmo entre os radiologistas menos experientes.

Reproducibility and interobserver agreement of the R.E.N.A.L. nephrometry score: focus on imaging features / Reprodutibilidade e concordância interobservador do escore nefrométrico R.E.N.A.L.: ênfase nos achados de imagem

Abstract Objective: To investigate the reproducibility and interobserver agreement for R.E.N.A.L. nephrometry scoring system. Materials and Methods: Two independent radiologists retrospectively analyzed 46 consecutive patients with renal masses, between 2008 and 2012, using the R.E.N.A.L. nephrometry score (RENAL-NS), which is based on the evaluation of five anatomical features of the tumor, as evaluated with computed tomography or magnetic resonance imaging: Radius, Exophytic/endophytic properties, Nearness to the collecting system, Anterior or posterior descriptor, and Location relative to the polar line. Tumor complexity was graded as low, intermediate, or high. The interobserver agreement was calculated for the total score and for the score for each parameter. Surgical excision of the tumors was used as the standard of reference. Results: The interobserver agreement for each of the RENAL-NS parameters, respectively, a hilar location, and the total score was 98%, 80%, 100%, 89%, 85%, 89%, and 93% of patients, corresponding to kappa values of 0.96, 0.65, 1.00, 0.75, 0.72, 0.78, and 0.88, respectively. The Nearness, Radius, and total score showed the best agreement. For the cases that were discordant in terms of the final score, no major implications in surgical planning were observed. Conclusion: The RENAL-NS is a structured, useful system to assess the anatomical features of renal tumors. It is easily applicable and reproducible, even for less experienced radiologists.

Resumo Objetivo: Investigar a concordância interobservador e a reprodutibilidade do sistema de pontuação nefrométrico R.E.N.A.L. nephrometry score (RENAL-NS) usando imagens de tomografia computadorizada e ressonância magnética. Materiais e Métodos: Dois observadores independentes analisaram, retrospectivamente, 46 pacientes com massas renais, consecutivos, de 2008 a 2012. Cinco características anatômicas foram avaliadas: raio (R); localização exofítico/endofítico (E); proximidade do tumor ao sistema coletor (N, nearness); posição anterior (A) ou posterior e de localização em relação à linha polar (L). Os tumores foram classificados em baixo, intermediário ou alto grau de complexidade. A concordância foi calculada para cada parâmetro do escore e para o valor global. A excisão cirúrgica das lesões foi utilizada como padrão de referência. Resultados: A concordância para cada um dos parâmetros renais, para a característica de "h", e para a pontuação final foi 98%, 80%, 100%, 89%, 85%, 89% e 93% dos pacientes, o que corresponde a valores de kappa de 0,96, 0,65, 1,00, 0,75, 0,72, 0,78 e 0,88, respectivamente. Os parâmetros "N", "R" e o escore global mostraram as melhores concordâncias. Entre os casos discordantes na pontuação final, não foram observadas grandes mudanças no planejamento cirúrgico. Conclusão: O RENAL-NS é um sistema estruturado, útil para avaliar características anatômicas do tumor renal. É de fácil aplicação, reprodutível, mesmo entre os radiologistas menos experientes.

Is a visible (hypoechoic) lesion at biopsy an independent predictor of prostate cancer outcome?

The aim of this study was to evaluate the prognostic implications of the sonographic appearance of prostate cancers. All patients with biopsy-proven prostate cancer between January 2003 and July 2004 (and at least 5 years of follow-up) were selected retrospectively. After exclusions, 101 patients constituted our study population and were divided into isoechoic (or nonvisible) and hypoechoic (or visible) lesion. The clinical outcomes of these two groups were compared. The outcomes for the two groups were significantly different (p < 0.01). For nonvisible lesions, 37 of the 41 patients (90.2%) had no disease relapse and 2 (4.9%) had biochemical failure. For the visible lesions, 37 of the 60 (61.6%) patients were free of recurrence, 7 (11.7%) had systemic metastases and 10 (16.7%) died of complications related to prostate cancer. Our data show that patients with nonvisible prostate cancer had significantly better outcomes than patients with visible lesions during a five-year period of evaluation.