Assessment of adult renal cell carcinoma types presenting to a tertiary care hospital in Sri Lanka and the intraobserver variability of two nuclear grading systems for clear cell renal cell carcinoma

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Original Article

Author Details : Labandi Malhasi Gunawardena*, Modini Manohari Abeydera Jayawickrama, Menaka Dilani Samarawickrema Lokuhetty

Volume : 11, Issue : 3, Year : 2024

Article Page : 248-255

https://doi.org/10.18231/j.ijpo.2024.056

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Abstract

Background: The histomorphology remains the foundation in classification of renal cell carcinoma (RCC). The nuclear grading is significant in prognostication of certain subtypes for which Fuhrman system was used before the introduction of WHO/ISUP system in 2012.
Aims and Objectives: To describe types of adult RCC presenting to a tertiary care hospital in Sri Lanka and to assess intraobserver variability of two nuclear grading systems for clear cell RCC.
Materials and Methods: One representative H and E stained slide from all RCC reported in National Hospital of Sri Lanka and University of Colombo, Sri Lanka from 2016-2020 were selected (n = 228). Tumours were classified by morphology according to WHO-5th series. Two rounds each of nuclear grade assessment using Fuhrman and WHO/ISUP systems were performed on clear cell RCC (n = 189) to calculate intraobserver agreement using kappa index (SPSS 25.0).
Results: Of the 228 cases 189 were of clear cell (82.9%), 24 were papillary (10.5%) and 6 were chromophobe (2.6%). Seven were identified requiring molecular testing for accurate diagnosis (3.1%). Kappa value was 0.953 for WHO/ISUP (95% confidence interval 0.916 – 0.99) and 0.856 for Fuhrman system (95% confidence interval 0.794 – 0.918).
Conclusions: Majority of the RCC were clear cell, followed by papillary and chromophobe. Other subtypes were rare. A few required molecular testing for diagnosis. WHO/ISUP system showed an almost perfect level of intraobserver agreement. Although discordant with many studies, Fuhrman system also demonstrated a strong level of intraobserver agreement.
 

Keywords: Renal cell carcinoma, Fuhrman, Intraobserver variability, Kappa.

How to cite : Gunawardena L M, Jayawickrama M M A, Lokuhetty M D S, Assessment of adult renal cell carcinoma types presenting to a tertiary care hospital in Sri Lanka and the intraobserver variability of two nuclear grading systems for clear cell renal cell carcinoma. Indian J Pathol Oncol 2024;11(3):248-255

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