TY - JOUR
T1 - Application of a new histological staging and grading system for primary biliary cirrhosis to liver biopsy specimens
T2 - Interobserver agreement
AU - Nakanuma, Yasuni
AU - Zen, Yoh
AU - Harada, Kenichi
AU - Sasaki, Motoko
AU - Nonomura, Akitaka
AU - Uehara, Takeshi
AU - Sano, Kenji
AU - Kondo, Fukuo
AU - Fukusato, Toshio
AU - Tsuneyama, Koichi
AU - Ito, Masahiro
AU - Wakasa, Kenichi
AU - Nomoto, Minoru
AU - Minato, Hiroshi
AU - Haga, Hironori
AU - Kage, Masayoshi
AU - Yano, Hirohisa
AU - Haratake, Joji
AU - Aishima, Shinichi
AU - Masuda, Tomoyuki
AU - Aoyama, Hajime
AU - Miyakawa-Hayashino, Aya
AU - Matsumoto, Toshiharu
AU - Sanefuji, Hayato
AU - Ojima, Hidenori
AU - Chen, Tse Ching
AU - Yu, Eunsil
AU - Kim, Ji Hun
AU - Park, Young Nyun
AU - Tsui, Wilson
PY - 2010/3/1
Y1 - 2010/3/1
N2 - Recently the authors proposed a new staging and grading system for primary biliary cirrhosis (PBC) that takes into account necroinflammatory activity and histological heterogeneity. Herein is proposed a convenient version of this system. Scores for fibrosis, bile duct loss, and chronic cholestasis were combined for staging: stage 1, total score of 0; stage 2, score 1-3; stage 3, score 4-6; and stage 4, score 7-9. Cholangitis activity (CA) and hepatitis activity (HA) were graded as CA0-3, and HA0-3, respectively. Analysis of interobserver agreement was then conducted. Digital images of 62 needle liver biopsy specimens of PBC were recorded as virtual slides on DVDs that were sent to 28 pathologists, including five located overseas. All participants were able to apply this version in all 62 cases. For staging, kappa was 0.385 (fair agreement) and the concordance rate was 63.9%. For necroinflammatory activity, the kappa and concordance rate were 0.110 (slight agreement) and 36.9% for CA, and 0.197 (slight agreement) and 47% for HA, respectively. In conclusion, this new staging and grading system for PBC seems to be more convenient and practical than those used at present, but more instruction and guidance are recommended for the grading of necroinflammatory activity in practice.
AB - Recently the authors proposed a new staging and grading system for primary biliary cirrhosis (PBC) that takes into account necroinflammatory activity and histological heterogeneity. Herein is proposed a convenient version of this system. Scores for fibrosis, bile duct loss, and chronic cholestasis were combined for staging: stage 1, total score of 0; stage 2, score 1-3; stage 3, score 4-6; and stage 4, score 7-9. Cholangitis activity (CA) and hepatitis activity (HA) were graded as CA0-3, and HA0-3, respectively. Analysis of interobserver agreement was then conducted. Digital images of 62 needle liver biopsy specimens of PBC were recorded as virtual slides on DVDs that were sent to 28 pathologists, including five located overseas. All participants were able to apply this version in all 62 cases. For staging, kappa was 0.385 (fair agreement) and the concordance rate was 63.9%. For necroinflammatory activity, the kappa and concordance rate were 0.110 (slight agreement) and 36.9% for CA, and 0.197 (slight agreement) and 47% for HA, respectively. In conclusion, this new staging and grading system for PBC seems to be more convenient and practical than those used at present, but more instruction and guidance are recommended for the grading of necroinflammatory activity in practice.
KW - Cholangitis
KW - Fibrosis
KW - Hepatitis
KW - Primary biliary cirrhosis
KW - Staging and grading
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UR - http://www.scopus.com/inward/citedby.url?scp=77649139779&partnerID=8YFLogxK
U2 - 10.1111/j.1440-1827.2009.02500.x
DO - 10.1111/j.1440-1827.2009.02500.x
M3 - Article
C2 - 20403042
AN - SCOPUS:77649139779
VL - 60
SP - 167
EP - 174
JO - Pathology International
JF - Pathology International
SN - 1320-5463
IS - 3
ER -