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WHO/ISUP grade vs Fuhrman

Posts: 14
Joined: Apr 2019

Happy Friday peep!

I'm not sure if this has been already discused here, but pathology reports over the last 5 years or so have embraced the WHO/ISUP grade for the surgicl tumor as opposed to the Fuhrmans which was pretty much the norm for ccRCC. I have observed that a lot of research data (including nomograms) for pronosis, surveillance etc is still based upon Fuhrmans grading. In my pathology report I was only given the WHO/ISUP grade (G2) without any mention of Fuhrman.

Considering they had to re-define grading metrics, I'm assuming they are not apple to apple comparisons and there are some subtle variations with respect to magnification and nucleoli size. Is there a possibility that if I m G2 on ISUP, I could be a G3 on Fuhrman? I have done some research and haven't found anything definitive, yet. Would appreciate if others have any inputs in this topic. Thnk you


stub1969's picture
Posts: 888
Joined: Jul 2016

This is a really good question, Percy, but way above my pay grade to provide an answer.  I look forward to reading responses about this post.  



Posts: 564
Joined: Nov 2013

I hesitate to comment as this is somewhat beyond my scope.  I do know that the purpose of changing from Fuhrman to ISUP was to have an international grading system.  Through research they found that Furhman scores were not as good of predictors for a patients prognosis as the ISUP.   A study showed that some scores improved when changed to the new system.  

On a personal note, we avoid all statistics.  The reason is because they are basically worthless.  You cant know whether or not you are the exception.  I dont think anyone should read survival stats.  What purpose could that serve?

Allochka's picture
Posts: 947
Joined: Nov 2014

Oaklee is the right - statistics are evil!

regarding the grade (all said is just my guessing based on what I’ve read). As I understand, in terms of agressiveness/prognosis ISUP and Furman grades correspond to each other . ISUP 1 equals Furman 1, etc. But ISUP grading is more precise due to more simple and straightforward criteria used. So, assigned Furman grade could potentially be wrong ( e.g. Furman grade  2 could actually be upgraded to grade 3 when reviewed with ISUP criteria), but not vice versa. Your tumor was ISUP grade 2. Theoretically another pathologist using Furman grading could classify it as grade 3. But due to ambiguous nature of Furman criteria, this parhologist would most probably be wrong, and the one using ISUP - right. So despite stamping it as Furman grade 3, it would still actually be grade 2 in terms of agressiveness/prognosis, as more precise ISUP system defined. And you could still use grade 2 statistics made for Furman scale, cause it’s  2. 

I hope I was able to explain it more or less clearly, English is not my native language :-)

Posts: 14
Joined: Apr 2019

Thanks everyone for your input. I agree with you all - I should know better than to get sucked into stats! Rookie mistake ;). Oaklee and Allochka thanks for the explanation between the two systems. I actually feel pretty comfortable with my ISUP grade 2 and I’m not going to worry about Fuhrman. On a totally different note, I reached out to a couple of oncologists and neither of them see a need for me to be under their care. I just don’t want to see a random one without much experience in RCC.

Allochka, your message was super clear. I’m not a native English speaker either and I hope I have been able to express myself clearly. Everyone here are so kind and considerate and very knowledgeable. 

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