3D Banff Glomerulitis Scoring for Kidney Transplant Pathology: Feasibility Study for Volumetric Quantification

Yanfan Zhu, Junchao Zhu, Ruining Deng, Shilin Zhao, Yu Wang +10

Quantifying glomerular inflammation in kidney-transplant biopsies is traditionally performed on single whole-slide sections using the Banff "most-severe section" rule, despite the inherently three-dimensional nature of lesion distribution. This 2D based assessment might lead to instability when inflammation varies across slices. This paper reports a feasibility study examining the technical feasibility and clinical relevance of extending Banff scoring into three dimensions. To this end, we propose a 3D Banff lesion-scoring framework that aligns serial sections, reconstructs glomerular identities across depth, and integrates inflammatory-cell counts in 3D under three scoring strategies: Compatible, Volumetric, and Deduplicated Volumetric. In the experiments, glomerulitis (g-scores) was used as an example Banff metric and applied to multi-section renal allograft biopsies. Our findings indicate that 3D Banff g-scores are more consistent across sections and, under the semi-automatic setting, the Volumetric strategy correlates more strongly with clinical biomarkers than traditional 2D scores. These results show that 3D volumetric quantification offers promising added value,…