{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T18:38:23Z","timestamp":1792694303087,"version":"4.5.0"},"reference-count":12,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T00:00:00Z","timestamp":1774483200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Int J Surg Pathol"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:p>\n                    Traditional WHO grading for renal cell carcinoma (RCC), largely based on nucleolar prominence, has well-known intraobserver and interobserver variability. In the era of digital pathology, quantitative guidelines may be more accurate and reproducible. Herein, we investigate nucleolar size in clear cell RCC using digital quantification methods compared to traditional pathologist WHO Grade allocation. We reviewed nephrectomy specimens containing clear cell RCC at a subspecialized academic center, initially diagnosed as WHO Grade 2 or 3. Digital scans were initially reviewed without knowledge of the originally assigned WHO Grade. Within a 0.25 mm\n                    <jats:sup>2<\/jats:sup>\n                    area of the visually assessed highest tumor grade in each tumor, nucleolar diameters were digitally measured. Of 100 tumors reviewed, 50 (50%) were originally diagnosed as WHO Grade 2 and 50 (50%) as WHO Grade 3. The mean nucleolar diameter was significantly different between tumors assigned as WHO Grade 2 versus Grade 3 (2.087\u2009\u00b1\u20090.256 SD \u00b5m vs 2.813\u2009\u00b1\u20090.408 SD \u00b5m, p\u2009&lt;\u20090.001). However, scatterplot evaluation showed significant overlap in digitally assessed nucleolar size between the grades, with 54% WHO Grade 2 and 44% WHO Grade 3 tumors showing nucleolar diameter between 2.07 and 2.76 um. Clear cell RCC assigned as WHO Grade 2 and Grade 3 by traditional methods show significant overlap in digitally measured nucleolar size, suggesting accuracy for grading based on nucleolar size could be improved. Additional outcome-based studies to identify appropriate size cut-offs and potential training of artificial intelligence models to automate grading may provide improved risk stratification by grade for clear cell RCC.\n                  <\/jats:p>","DOI":"10.1177\/10668969261429048","type":"journal-article","created":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T08:30:27Z","timestamp":1774513827000},"page":"1435-1439","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Digitally Assessed Nucleolar Size Compared to Traditional Pathologist WHO Grade Allocation in Clear Cell Renal Cell Carcinoma"],"prefix":"10.1177","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0774-9340","authenticated-orcid":false,"given":"Mariya","family":"Kuk","sequence":"first","affiliation":[{"name":"Stanford University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alarice","family":"Lowe","sequence":"additional","affiliation":[{"name":"Stanford University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0874-8964","authenticated-orcid":false,"given":"Ankur R.","family":"Sangoi","sequence":"additional","affiliation":[{"name":"Stanford University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7290-4004","authenticated-orcid":false,"given":"Emily","family":"Chan","sequence":"additional","affiliation":[{"name":"Stanford University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,3,26]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1111\/his.13735"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000478-198210000-00007"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1038\/modpathol.2008.183"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/PAS.0b013e318220697f"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/PAS.0b013e318299f0fb"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1111\/his.13311"},{"key":"e_1_3_3_8_2","volume-title":"WHO Classification of Tumours of the Urinary System and Male Genital Organs. 4th ed","author":"Moch H","year":"2016","unstructured":"Moch H, Humphrey PA, Ulbright TM, et al. WHO Classification of Tumours of the Urinary System and Male Genital Organs. 4th ed. International Agency for Research on Cancer; 2016."},{"key":"e_1_3_3_9_2","volume-title":"WHO Classification of Tumours Urinary and Male Genital Tumours. 5th ed","author":"Board WCoTE","year":"2022","unstructured":"Board WCoTE. WHO Classification of Tumours Urinary and Male Genital Tumours. 5th ed. International Agency for Research on Cancer; 2022."},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00345-018-2447-8"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13000-021-01130-2"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1111\/his.70030"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.urology.2020.05.094"}],"container-title":["International Journal of Surgical Pathology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10668969261429048","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10668969261429048","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10668969261429048","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T17:43:41Z","timestamp":1792691021000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/10668969261429048"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,26]]},"references-count":12,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1177\/10668969261429048"],"URL":"https:\/\/doi.org\/10.1177\/10668969261429048","relation":{},"ISSN":["1066-8969","1940-2465"],"issn-type":[{"value":"1066-8969","type":"print"},{"value":"1940-2465","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,26]]}}}