Observer variation in assessment of liver biopsies of alcoholic patients.
The aim was to construct a questionnaire analyzing pathological features possibly present in alcoholic liver disease, to assess its interobserver variation and to determine the influence of technical data on this variation. A total of 764 inpatients drinking 90 g (median) of pure alcohol per day for 25 years was observed; 402 patients were excluded because of associated nonalcoholic disease, refusal or contraindication to biopsy, leaving 362 patients included. Two pathologists independently analyzed each biopsy and completed a questionnaire including 41 items. Coefficient of concordance between observers was evaluated with the kappa statistic (k). The prevalence of 14 lesions was low, equal to or under 10%, leading to a nonsignificant concordance. For the 27 remaining features, two had an almost perfect degree of concordance (k greater than 0.81): presence of hepatocellular carcinoma and cirrhosis. Three had a substantial coefficient of concordance (k greater than 0.61): fibrous septa, size of cirrhotic nodules, and liver cell regeneration. Nine had a moderate (k greater than 0.41), 11 a fair (k greater than 0.21), and two a slight (k less than 0.21) coefficient of concordance. In terms of final diagnosis of alcoholic liver disease the concordance was substantial for cirrhosis with acute alcoholic hepatitis (k = 0.77), cirrhosis without alcoholic hepatitis (k = 0.75), acute alcoholic hepatitis without cirrhosis (k = 0.65) and normal liver (k = 0.64). Concordance was moderate for steatosis (k = 0.47) and slight for fibrosis alone (k = 0.16).(ABSTRACT TRUNCATED AT 250 WORDS)
Bedossa
P
P
Service d'Hépato-Gastroentérologie, Hôpital Antoine Béclère, Clamart, France.
Poynard
T
T
Naveau
S
S
Martin
E D
ED
Agostini
H
H
Chaput
J C
JC
D000437:Alcoholism / Q000473:pathology*; D001707:Biopsy, Needle; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology*; D008104:Liver Cirrhosis, Alcoholic / Q000473:pathology; D008108:Liver Diseases, Alcoholic / Q000473:pathology*; D008297:Male; D008875:Middle Aged