The clinical management of @entity5 @entity1 is often strongly influenced by the @entity5 grade. The presence of heterogeneity is well recognized in a variety of @entity5 . Overall grade is based on highest grade area identified within a @entity5 . @entity189 often contains different histological grades within the same @entity5 . This study investigates the impact of a combined grading system on the reproducibility of @entity4929 . A set prepared for an earlier study consisting of ten cases of each category ( @entity4929 of low malignant potential (PUNLMP), LGPUC, and HGPUC) was used. Agreement between pairs of pathologists was evaluated using k statistics for the combined scoring system. Interobserver agreement was fair to substantial as reflected by k values ranging from 0.24 to 0.74 (mean k   =   0.43). The combined scores of 2 and 3 which included PUNLMP showed the lowest degree of agreement and when this category was excluded from the analysis, interobserver agreement increased significantly (mean k   =   0.65; ranging from 0.43 to 0.92) in terms of combined scores of 4, 5, and 6. PUNLMP has been shown to be the least reproducible component of a combined scoring system even among experienced observers. Exclusion of PUNLMP from grading scheme seems to improve interobserver variability.

Histologic grading of XXXX : impact of combined grading (two-numbered grading system) on reproducibility.

@entity5 :: ('MESH:D009369', 'Disease') :: ['tumor', 'tumors'] @entity1 :: ('9606', 'Species') :: ['patients'] @entity4929 :: ('MESH:C565310', 'Disease') :: ['papillary urothelial neoplasms', 'papillary urothelial neoplasm'] @entity189 :: ('MESH:D002277', 'Disease') :: ['Urothelial carcinoma']
@entity4929 :: (MESH:C565310,Disease) :: ['urothelial papillary neoplasms']
