Sampling error and intraobserver variation in liver biopsy in patients with chronic HCV infection
Sampling error and intraobserver variation in liver biopsy in patients with chronic HCV infection
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DOI：
10.1111/j.1572-0241.2002.06038.x
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发表时间：
2002-10-01
影响因子：
9.8
通讯作者：
Schiff, ER
中科院分区：
文献类型：
--
作者：
Regev, A;Berho, M;Schiff, ER
结论：在弥漫性肝实质疾病患者中，肝穿刺活检的采样错误率很高。在这些情况下，尽管样本量足够，但肝组织样本并不能反映炎症、纤维化或肝硬化的真实程度。本研究的目的是确定慢性丙型肝炎病毒感染患者的抽样误差率和程度，并评估观察者内的变化与常用的评分系统提出的Scheuer和修改的Batts和Ludwig.METHODS：共124例慢性丙型肝炎病毒感染患者进行了同时腹腔镜引导下肝右叶和肝左叶活检。福尔马林固定的石蜡包埋切片用苏木精和伊红以及三色染色。对切片进行盲法编码，并随机分配给两位肝脏病理学家。根据基于改良Scheuer系统的标准分级（炎症）和分期（纤维化）方法对炎症和纤维化进行评分。判读后，对切片进行未编码，以比较右叶和左叶的结果。50个样本被盲目地重新提交给每一个病理学家，以确定观察者内variation.Results：30 124例（24.2%）有至少一个等级的差异，和41 124例（33.1%）之间的右叶和左叶至少一个阶段的差异。在18例患者（14.5%）中，一个肺叶被解释为肝硬化，而另一个肺叶被解释为3期纤维化。两个阶段或两个等级的差异分别只有3例（2.4%）和2例（1.6%）。在50个进行两次检查的样本中，第二次检查时每位病理学家的分级与第一次检查的差异分别为0%和4%，分期差异分别为6%和10%。所有观察到的变化是一个等级或一个stages.Conclusions：肝活检标本取自右肝叶和左肝叶不同的组织学分级和分期在很大比例的慢性丙型肝炎病毒患者，但是，一个以上的阶段或等级的差异是罕见的。抽样错误可能导致14.5%的患者肝硬化诊断不足。这些差异不能归因于观察者内变异，其似乎较低。
OBJECTIVES: Needle liver biopsy has been shown to have a high rate of sampling error in patients with diffuse parenchymal liver diseases. In these cases, the sample of liver tissue does not reflect the true degree of inflammation, fibrosis, or cirrhosis, despite an adequate sample size. The aim of this study was to determine the rate and extent of sampling error in patients with chronic hepatitis C virus infection, and to assess the intraobserver variation with the commonly used scoring system proposed by Scheuer and modified by Batts and Ludwig.METHODS: A total of 124 patients with chronic hepatitis C virus infection underwent simultaneous laparoscopy-guided biopsies of the right and left hepatic lobes. Formalin-fixed paraffin-embedded sections were stained with hematoxylin and eosin and with trichrome. The slides were blindly coded and randomly divided among two hepatopathologists. Inflammation and fibrosis were scored according to the standard grading (inflammation) and staging (fibrosis) method based on the modified Scheuer system. Following the interpretation, the slides were uncoded to compare the results of the right and left lobes. Fifty of the samples were blindly resubmitted to each of the pathologists to determine the intraobserver variation.RESULTS: Thirty of 124 patients (24.2%) had a difference of at least one grade, and 41 of 124 patients (33.1%) had a difference of at least one stage between the right and left lobes. In 18 patients (14.5%), interpretation of cirrhosis was given in one lobe, whereas stage 3 fibrosis was given in the other. A difference of two stages or two grades was found in only three (2.4%) and two (1.6%) patients, respectively. Of the 50 samples that were examined twice, the grading by each pathologist on the second examination differed from the first examination in 0% and 4%, and the staging differed in 6% and 10%, respectively. All observed variations were of one grade or one stage.CONCLUSIONS: Liver biopsy samples taken from the right and left hepatic lobes differed in histological grading and staging in a large proportion of chronic hepatitis C virus patients; however, differences of more than one stage or grade were uncommon. A sampling error may have led to underdiagnosis of cirrhosis in 14.5% of the patients. These differences could not be attributed to intraobserver variation, which appeared to be low.