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This study assessed concordance between central and institutional reviews to inform future clinical trials and real\u2010world practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Procedure<\/jats:title>\n                    <jats:p>Eligible patients who enrolled on AREN03B2 from 2006 to 2019 were included. COG experts performed real\u2010time central radiology review to assess lung metastasis and bilateral renal lesions, pathology review for histology and pathological stage, and surgery review of local staging. An initial risk assignment (IRA) was made based on these reviews. Concordance between institutional and central reviews was measured using raw rates of agreement (%) and Cohen's kappa coefficient for inter\u2010rater reliability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>6311 patients were included. Raw rate of agreement between institutional and central pathological diagnosis was 91.1% (Cohen's kappa: 0.79 [95% CI: 0.78\u20130.81]). Among patients with unilateral tumors, only 181\/269 (67%) with diffuse anaplastic Wilms tumor were correctly identified by local institutions. Raw rate of agreement between assessments of computed tomography (CT) scans for lung nodules was 96.1% (Cohen's kappa: 0.88 [95% CI: 0.86\u20130.89]). Raw rate of agreement between surgical reviews for local stage was 90% (Cohen's kappa: 0.84 [95% CI: 0.83\u20130.85]). Raw rate of agreement between calculated institutional and central IRA was 87% (Cohen's kappa: 0.84 [95% CI: 0.83\u20130.85]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Central reviews were highly concordant with institutional assessments, though lack of recognition of anaplastic histology by institutional pathologists was notable. Institutions should consider expert pathology consultation in the absence of a clinical trial with integrated central review.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/1545-5017.70515","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T13:45:39Z","timestamp":1785851139000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Concordance Between Institutional and Central Pathology, Surgery, and Radiology Reviews on the Children's Oncology Group AREN03B2 Renal Tumor Biology and Classification Study"],"prefix":"10.1002","volume":"73","author":[{"given":"Elizabeth A.","family":"Mullen","sequence":"first","affiliation":[{"name":"Dana\u2010Farber\/Boston Children's Cancer and Blood Disorders Center Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsay A.","family":"Renfro","sequence":"additional","affiliation":[{"name":"Division of Biostatistics University of Southern California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter F.","family":"Ehrlich","sequence":"additional","affiliation":[{"name":"Section of Pediatric Surgery University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geetika","family":"Khanna","sequence":"additional","affiliation":[{"name":"Children's Healthcare of Atlanta and the Department of Radiology &amp; Imaging Sciences Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric J.","family":"Gratias","sequence":"additional","affiliation":[{"name":"UnitedHealthcare Clinical Services  Minnetonka Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas G.","family":"Cost","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Urology University of Colorado School of Medicine and The Surgical Oncology Program at the Children's Hospital of Colorado  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren N.","family":"Parsons","sequence":"additional","affiliation":[{"name":"Medical College of Wisconsin Children's Hospital of Wisconsin  Milwaukee Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul E.","family":"Grundy","sequence":"additional","affiliation":[{"name":"Division of Immunology, Hematology, Oncology, Palliative Care and Environmental Interactions University of Alberta  Edmonton Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Conrad V.","family":"Fernandez","sequence":"additional","affiliation":[{"name":"Division of Pediatric Hematology\/Oncology IWK Health Centre, Dalhousie University  Halifax Nova Scotia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James I.","family":"Geller","sequence":"additional","affiliation":[{"name":"Peckham Center for Cancer and Blood Disorders Rady Children's Hospital  San Diego California USA"},{"name":"Division of Pediatric Hematology\/Oncology Department of Pediatrics University of California San Diego  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey S.","family":"Dome","sequence":"additional","affiliation":[{"name":"Division of Oncology, Children's National Hospital and the Department of Pediatrics George Washington University School of Medicine and Health Sciences  Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the AREN03B2 study committee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,4]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2021.7070"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.14694\/EdBook_AM.2014.34.215"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.30586"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2005.04.7852"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.24214"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000001716"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2017.73.7999"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2017.77.1931"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.18.01972"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000002356"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.19.01265"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2019.05.033"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2392050631"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO-25-00532"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2013.09.047"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.2307\/2529310"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2011.41.1165"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.35084"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.22.00098"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1997.15.7.2631"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.29759"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.19.22301"}],"container-title":["Pediatric Blood &amp; 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