Interobserver Variability in Histologic Evaluation of Liver Fibrosis Using Categorical and Quantitative Scores

Overview

Journal Am J Clin Pathol

Publisher Oxford University Press

Specialty Pathology

Date 2017 Mar 25

PMID 28340131

Citations 23

Authors

Michael Pavlides

Jacqueline Birks

Eve Fryer

David Delaney

Nikita Sarania

Rajarshi Banerjee

Stefan Neubauer

Eleanor Barnes

Kenneth A Fleming

Lai Mun Wang

Affiliations

Soon will be listed here.

Abstract

Objectives: The aim of the study was to investigate the interobserver agreement for categorical and quantitative scores of liver fibrosis.

Methods: Sixty-five consecutive biopsy specimens from patients with mixed liver disease etiologies were assessed by three pathologists using the Ishak and nonalcoholic steatohepatitis Clinical Research Network (NASH CRN) scoring systems, and the fibrosis area (collagen proportionate area [CPA]) was estimated by visual inspection (visual-CPA). A subset of 20 biopsy specimens was analyzed using digital imaging analysis (DIA) for the measurement of CPA (DIA-CPA).

Results: The bivariate weighted κ between any two pathologists ranged from 0.57 to 0.67 for Ishak staging and from 0.47 to 0.57 for the NASH CRN staging. Bland-Altman analysis showed poor agreement between all possible pathologist pairings for visual-CPA but good agreement between all pathologist pairings for DIA-CPA. There was good agreement between the two pathologists who assessed biopsy specimens by visual-CPA and DIA-CPA. The intraclass correlation coefficient, which is equivalent to the κ statistic for continuous variables, was 0.78 for visual-CPA and 0.97 for DIA-CPA.

Conclusions: These results suggest that DIA-CPA is the most robust method for assessing liver fibrosis followed by visual-CPA. Categorical scores perform less well than both the quantitative CPA scores assessed here.

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