{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T14:03:06Z","timestamp":1789912986153,"version":"4.0.1"},"reference-count":22,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"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"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Grading of clear cell renal cell carcinoma now focuses on the prominence of the nucleolus; however, there may be variability in how pathologists interpret this criterion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>An online survey was distributed via email and social media to pathologists.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Excluding trainees, 91 responses were received, including 77 self-identified as genitourinary (GU) and 14 non-GU. Most did not require nucleoli to be eosinophilic when determining visibility (78% GU and 71% non-GU). Most indicated that nucleoli visualized at 40\u00d7 magnification at all would be considered grade 2, even if nucleoli are not eosinophilic\/large (69% GU and 57% non-GU), with similar results for grade 2 versus 3 (10\u00d7) at 61% GU and 71% non-GU. For a photomicrograph at 40\u00d7 magnification with visible but basophilic nucleoli, most reported grade 2 (96% GU and 79% non-GU). For an image with more prominent nucleoli described as visible at 10\u00d7, 84% of GU and 71% non-GU reported grade 3. Respondents estimated using grade 1 in 5% or less of resection specimens (76% GU, 58% non-GU). For multinucleated cells with bland individual nuclei, most (83% GU, 86% non-GU) would not consider this grade 4.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Although grading guidelines indicate that renal cell carcinoma nucleoli should be prominent\/eosinophilic to assign grade 2 or 3, most pathologists assign the higher grade if nucleoli are visible at all. Further refinement is needed for grading cells with multiple but non-bizarre nuclei.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10668969261486375","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T13:45:28Z","timestamp":1789739128000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Persistent Challenges in Nuclear Grading of Clear Cell Renal Cell Carcinoma: A Survey of Pathologists"],"prefix":"10.1177","author":[{"given":"Kanika","family":"Arora","sequence":"first","affiliation":[{"name":"JPS Health System"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3898-1460","authenticated-orcid":false,"given":"Sean R.","family":"Williamson","sequence":"additional","affiliation":[{"name":"Diagnostics Institute, Cleveland Clinic"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1111\/his.13311"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/PAS.0b013e318299f0fb"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1111\/his.13735"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1590\/s1677-5538.ibju.2018.06.01"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/PAS.0b013e318220697f"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000478-198210000-00007"},{"key":"e_1_3_2_8_2","first-page":"14","volume-title":"WHO classification of tumours of the urinary system and male genital organs. In World Health Organization classification of tumours. 4th ed","author":"Moch H","year":"2016","unstructured":"Moch H, Amin MB, Argani P, et al. Renal cell tumours. In: Moch H, Humphrey PA, Ulbright TM, Reuter VE, eds. WHO classification of tumours of the urinary system and male genital organs. In World Health Organization classification of tumours. 4th ed. International Agency for Research on Cancer; 2016:14-17."},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.humpath.2013.10.033"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1093\/ajcp\/aqad096"},{"key":"e_1_3_2_11_2","unstructured":"Murugan P Allan RW Harik LR et al. Protocol for the Examination of Resection Specimens from Patients with Renal Cell Carcinoma: College of American Pathologists; 2025 [Available from: https:\/\/documents.cap.org\/documents\/New-Cancer-Protocols-June-2025\/Kidney_4.2.1.0.REL_CAPCP.pdf."},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1097\/PAS.0000000000000690"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/PAP.0000000000000341"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.14670\/HH-11-925"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13000-021-01130-2"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1111\/his.70030"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1177\/10668969261429048"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41379-021-00982-9"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1111\/pin.70012"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.humpath.2022.11.004"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1158\/0008-5472.CAN-21-2318"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ebiom.2019.10.052"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1097\/PAS.0000000000001025"}],"container-title":["International Journal of Surgical Pathology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10668969261486375","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10668969261486375","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10668969261486375","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T13:47:28Z","timestamp":1789912048000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/10668969261486375"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,18]]},"references-count":22,"alternative-id":["10.1177\/10668969261486375"],"URL":"https:\/\/doi.org\/10.1177\/10668969261486375","relation":{},"ISSN":["1066-8969","1940-2465"],"issn-type":[{"value":"1066-8969","type":"print"},{"value":"1940-2465","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,18]]},"article-number":"10668969261486375"}}