Interobserver Variability in Scoring Liver Biopsies with a Diagnosis of Alcoholic Hepatitis.
Interobserver Variability in Scoring Liver Biopsies with a Diagnosis of Alcoholic Hepatitis.
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诊断酒精性肝炎时肝活检评分的观察者间差异。
DOI：
10.1111/acer.13438
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发表时间：
2017
期刊：
影响因子：
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通讯作者：
Liu,Xiuli
中科院分区：
文献类型：
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作者：
Horvath,Bela;Allende,Daniela;Xie,Hao;Guirguis,John;Jeung,Jennifer;Lapinski,James;Patil,Deepa;McCullough,ArthurJ;Dasarathy,Srinivasan;Liu,Xiuli
研究背景酒精性肝炎（Alcoholic Hepatitis，AH）是酒精性肝病中最严重的一种.最近，一个组织学评分系统预测预后在这个病人的队列被提议为酒精性肝炎组织学评分（AHHS）。我们的目的是评估观察者之间的差异，认识AH的组织学特征和这种差异对拟议的AHHS categories. MethodsHematoxylin-伊红和三色染色的载玻片从32例诊断为AH与肝活检1个月内的介绍（2000年至2015年）由5名病理学家审查，包括3名肝脏病理学家和2名对临床结果或结局不知情的胃肠道（GI）病理学家。评估AH的组织学特征，计算AHHS，并分配AHHS类别（轻度、中度、重度）。Fleiss' kappa系数（κ）分析用于确定观察者间一致性。结果5名评价者对AH的组织病理学特征存在轻度至中度的观察者间一致性，κ值范围为0.20（95%置信区间（CI）：0.03至0.46，巨线粒体）至0.52 [95% CI：0.40至0.68，多形核白细胞（PMN）浸润]。在分配AHHS类别时，仅存在相当程度的一致性（κ = 0.33，95% CI：0.20 - 0.51）。虽然3名肝脏病理学家和2名GI病理学家对总体纤维化和嗜酸性炎症进行了初步评价，但肝脏病理学家对红细胞淤积和巨线粒体的诊断更为一致。总体而言，所有肝脏病理学家将32例患者中的18例（56%）统一分配到AHHS类别，κ值为0.40（95%CI：0.22至0.60）。结论一般而言，AH的特征可以通过观察者间的轻度至中度一致性进行识别，并且观察者间在分配AHHS类别方面存在公平的一致性。本研究揭示的病理学家之间的显著观察者间差异可能会限制其在日常临床实践中的有用性。
BackgroundAlcoholic hepatitis (AH) is one of the most severe forms of alcoholic liver disease. Recently, a histologic scoring system for predicting prognosis in this patient cohort was proposed as Alcoholic Hepatitis Histologic Score (AHHS). We aimed to assess interobserver variability in recognizing histologic features of AH and the effect of this variability on the proposed AHHS categories.MethodsHematoxylin–eosin‐ and trichrome‐stained slides from 32 patients diagnosed with AH with liver biopsies within 1 month of presentation (2000 to 2015) were reviewed by 5 pathologists including 3 liver pathologists and 2 gastrointestinal (GI) pathologists masked to the clinical findings or outcome. Histologic features of AH were assessed, the AHHS was calculated, and an AHHS category (mild, moderate, severe) was assigned. The Fleiss’ kappa coefficient (κ) analysis was performed to determine the interobserver agreement.ResultsA slight‐to‐moderate level of interobserver agreement existed among 5 reviewers on histopathologic features of AH with κ value ranging from 0.20 (95% confidence interval (CI): 0.03 to 0.46, megamitochondria) to 0.52 [95% CI: 0.40 to 0.68, polymorphonuclear leukocyte (PMN) infiltration]. There was only a fair level of agreement in assigning AHHS category (κ = 0.33, 95% CI: 0.20 to 0.51). While overall fibrosis and neutrophilic inflammation were comparably evaluated by 3 liver pathologists and 2 GI pathologists, bilirubinostasis and megamitochondria were more consistently diagnosed by liver pathologists. Overall, 18 of 32 (56%) were uniformly assigned to an AHHS category by all liver pathologists with a κ value of 0.40 (95% CI: 0.22 to 0.60).ConclusionsIn general, features of AH can be recognized with a slight‐to‐moderate level of interobserver agreement and there was fair interobserver agreement on assigning an AHHS category. Significant interobserver variability among pathologists revealed by the current study can limit its usefulness in everyday clinical practice.