Interobserver variation in the histopathological assessment of nonalcoholic steatohepatitis
Interobserver variation in the histopathological assessment of nonalcoholic steatohepatitis
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DOI：
10.1016/j.hepres.2005.09.018
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发表时间：
2005-10-01
影响因子：
4.2
通讯作者：
Yoshimura, K
中科院分区：
文献类型：
--
作者：
Fukusato, T;Fukushima, J;Yoshimura, K
病理学评估被认为是诊断非酒精性脂肪性肝炎（NASH）的金标准。然而，对于诊断NASH所需的组织学特征没有一致的意见。在本研究中，8位经验丰富的肝脏病理学家独立阅读了21例NASH和疑似NASH病例的肝活检标本载玻片，并被要求评估组织病理学特征并做出诊断。病理学家之间的观察者间的变化进行了评估，kappa统计。在评估脂肪变性程度和纤维化分级方面存在显著、良好的一致性。关于脂肪变性的定位、纤维化的定位和糖原核的一致性是中等的。在评估脂肪变性类型、气球样变、小叶内坏死性炎症改变、门静脉炎症和嗜中性粒细胞浸润程度方面，仅观察到轻微或较差的一致性。因此，组织学变量的一致性不同。在NASH的诊断中观察到了显著的、中度的一致性，但在暗示性NASH的诊断中一致性较差。对于被认为是诊断基础的个体组织学发现，NASH诊断的一致性不高。总之，NASH的一些组织学特征可能有助于开发标准化和可靠的病理诊断和评分系统。(c)2005爱思唯尔爱尔兰有限公司保留所有权利。
Pathological assessment is considered as the gold standard for the diagnosis of nonalcoholic steatohepatitis (NASH). However, there is no agreement of histological features required for the diagnosis of NASH. In the present study, eight experienced hepatopathologists read liver biopsy specimen slides of 21 cases of NASH and suspected NASH independently and were asked to assess histopathological features and render a diagnosis. Interobserver variation among pathologists was evaluated by kappa statistics. Significant, good agreement was present in evaluation of the extent of steatosis and grade of fibrosis. Agreement was moderate concerning the localization of steatosis, localization of fibrosis, and glycogen nuclei. Only slight or poor agreement was seen in evaluation of type of steatosis, ballooning, intralobular necroinflammatory change, portal inflammation, and degree of neutrophilic infiltration. Thus the agreement varied for histological variables. Significant, moderate agreement was seen in the diagnosis of NASH but agreement was poor in the diagnosis of suggestive NASH. The agreement for the diagnosis of NASH was not high as for the individual histological findings that were thought to be the basis of the diagnosis. In conclusion, some histological features in NASH might prove useful for the development of a standardized and reliable pathological diagnosis and scoring system. (c) 2005 Elsevier Ireland Ltd. All rights reserved.