Fuhrman_Nuclear_Grade_ccRCC v.1
The Fuhrman Nuclear Grade for Clear Cell Renal Cell Carcinoma (ccRCC) tool uses the physical appearance of cells in renal tissue to provide a prognostic assessment of tumour cells.
The Fuhrman Nuclear Grade for Clear Cell Renal Cell Carcinoma (ccRCC) tool uses the physical appearance of cells in renal tissue to provide a prognostic assessment of tumour cells. This provides a pathological grading system specifically for RCC (of the clear cell type) which can be used to independantly predict cancer-specific survival. Higher grades correlates with a worsening prognosis.
To be used with patients who have clear cell Renal Cell Carcinomas (RCC) and where pathological assessments needed to visualise the cells are available. There are 4 variables that are scored and which contribute to the 4 grades: Nuclear diameter, Nuclear shape, Nucleoli and Bizzare often multilobed nuclei and/or spindle cells. The 5 year survival figures for each grade: Grade I: 96% Grade II: 84% Grade III: 59% Grade IV: 31% The criteria used for each grade on the 4 variables, are: Grade 1 The nuclei of the tumor cells are small (< 10 µm), hyperchromatic, and round (resembling mature lymphocytes), with no visible nucleoli and little detail in the chromatin, as shown in the image below. Grade 2 Using the 10× objective, the nuclei of the tumor cells are slightly larger (15 µm) with finely granular “open” chromatin but small, inconspicuous nucleoli (see the following image). The nucleoli are often present, and many appear as small chromocenters at 10× objective, with confirmation of their nature at higher power, but this does not count. Grade 3 Using the 10× objective, the nuclei of the tumor cells are larger (20 µm in size) and may be oval in shape, with coarsely granular chromatin (see the image below). The nucleoli are easily unequivocally recognizable. Grade 4 The nuclei are pleomorphic with open chromatin or hyperchromatic and single or multiple macronucleoli.
As there are no validated scoring systems for providing ccRCC survival, this tool and other associated tools (such as the SSIGN) should be used with sound clinical judgment to provide a more rounded prognostic picture.
Ref. 1: Fuhrman SA, Lasky LC, Limas C. Prognostic significance of morphologic parameters in renal cell carcinoma. Am J Surg Pathol. 1982 Oct;6(7):655-63. Ref. 2: Cancercentrum. Njurcancer, Nationell Kvalitetsregisterrapport. 2013. Available from: https://www.cancercentrum.se/globalassets/cancerdiagnoser/urinvagar/njurcancer/kvalitetsregister/njure_kvalregrapp_2014-11-21.pdf
openEHR-EHR-OBSERVATION.fuhrman_nuclear_grade_for_cc_renal_cell_carcinoma, openEHR-EHR-EVALUATION.fuhrman_nuclear_grade_ccrcc_assessment
