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Application of a new histological staging and grading system for primary biliary cirrhosis to liver biopsy specimens: Interobserver agreement
Author(s) -
Nakanuma Yasuni,
Zen Yoh,
Harada Kenichi,
Sasaki Motoko,
omura Akitaka,
Uehara Takeshi,
Sano Kenji,
Kondo Fukuo,
Fukusato Toshio,
Tsuneyama Koichi,
Ito Masahiro,
Wakasa Kenichi,
Nomoto Minoru,
Minato Hiroshi,
Haga Hironori,
Kage Masayoshi,
Yano Hirohisa,
Haratake Joji,
Aishima Shinichi,
Masuda Tomoyuki,
Aoyama Hajime,
MiyakawaHayashino Aya,
Matsumoto Toshiharu,
Sanefuji Hayato,
Ojima Hidenori,
Chen TseChing,
Yu Eunsil,
Kim JiHun,
Park Young Nyun,
Tsui Wilson
Publication year - 2010
Publication title -
pathology international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.73
H-Index - 74
eISSN - 1440-1827
pISSN - 1320-5463
DOI - 10.1111/j.1440-1827.2009.02500.x
Subject(s) - concordance , grading (engineering) , kappa , medicine , biopsy , primary biliary cirrhosis , cirrhosis , liver biopsy , stage (stratigraphy) , cholestasis , radiology , gastroenterology , bile duct , fibrosis , paleontology , linguistics , philosophy , civil engineering , biology , engineering
Recently the authors proposed a new staging and grading system for primary biliary cirrhosis (PBC) that takes into account necroinflammatory activity and histological heterogeneity. Herein is proposed a convenient version of this system. Scores for fibrosis, bile duct loss, and chronic cholestasis were combined for staging: stage 1, total score of 0; stage 2, score 1–3; stage 3, score 4–6; and stage 4, score 7–9. Cholangitis activity (CA) and hepatitis activity (HA) were graded as CA0–3, and HA0–3, respectively. Analysis of interobserver agreement was then conducted. Digital images of 62 needle liver biopsy specimens of PBC were recorded as virtual slides on DVDs that were sent to 28 pathologists, including five located overseas. All participants were able to apply this version in all 62 cases. For staging, kappa was 0.385 (fair agreement) and the concordance rate was 63.9%. For necroinflammatory activity, the kappa and concordance rate were 0.110 (slight agreement) and 36.9% for CA, and 0.197 (slight agreement) and 47% for HA, respectively. In conclusion, this new staging and grading system for PBC seems to be more convenient and practical than those used at present, but more instruction and guidance are recommended for the grading of necroinflammatory activity in practice.