Intraobserver and Interobserver Variations in Liver Biopsy
Interpretation in Patients with Chronic Hepatitis C
Authors: The French METAVIR Cooperative Study Group.
Journal: Hepatology 1994 Jul;20(1 Pt 1):15-20
Liver biopsy is used as the "gold standard" for the assessment of the stage and degree
of activity in chronic Hepatitis C and is of major importance in evaluating
the effects of treatment. Because numerous therapeutic trials are undertaken
with histological control, the reproducibility of liver biopsy interpretation
appears essential.
Therefore the aim of this study was to estimate intraobserver and interobserver
variations in the assessment of features, classification, and numerical scoring
of chronic viral Hepatitis C among 10 pathologists specializing in liver diseases.
These pathologists independently reviewed 30 liver biopsy specimens of viral
Hepatitis C and completed a histological form for each of the specimens. Five
pairs of pathologists then were randomly designated. They independently reviewed
the biopsy specimens and filled out a new coding form. The interobserver variation
was calculated for each item among the 10 individuals and then among the five
pairs with the intraclass correlation coefficient or kappa statistics. Five
features showed an almost perfect or a substantial degree of concordance
among the 10 observers (i.e., cirrhosis, fibrosis, fibrosis grading of Knodell index, steatosis,
portal lymphoid aggregates). The 17 other indicators showed a weaker concordance
with, for instance, a moderate degree of concordance for piecemeal necrosis,
disease activity, Knodell index, a
fair degree of concordance for lobular necrosis, and only a slight degree of
concordance for six items. Five items had a higher concordance when viewed by
a pair of pathologists than when studied by only one pathologist (i.e., steatosis,
periportal necrosis grading of Knodell index, lobular
necrosis grading of Knodell index, centrilobular
fibrosis, and ductular proliferation).
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