title: Are bile duct lesions of primary biliary cirrhosis distinguishable from those of autoimmune hepatitis and chronic viral hepatitis? Interobserver histological agreement on trimmed bile ducts.
abstract: BACKGROUND
  Primary biliary cirrhosis (PBC) is histopathologically characterized by chronic nonsuppurative destructive cholangitis and ductopenia of interlobular bile ducts. Bile duct injury is also often encountered in chronic viral hepatitis (CVH) and in autoimmune hepatitis (AIH).
  
  
  METHODS
  In this study, we performed interobserver agreement analysis on 90 injured bile ducts from liver specimens of PBC (17 cases), CVH (26 cases), and AIH (18 cases), with 30 bile ducts chosen from each disease group. Digital images of bile ducts with minimal periductal elements were recorded in CD-ROM format and sent to 14 observers (six special hepatopathologists, four local hepatopathologists, and four general pathologists). We analyzed the following issues: (1) diagnostic accuracy of PBC, based only on bile duct lesions; (2) classification of bile duct lesions in AIH cases as destructive cholangitis equivalent to PBC-associated injury, or not.
  
  
  RESULTS
  The diagnostic accuracy of PBC cases with severe bile duct injuries was very high (over 80%), although the accuracy in cases with only mild bile duct injuries was low (50% or less). For AIH, each observer classified 9 of the 30 bile ducts, on average, as destructive cholangitis.
  
  
  CONCLUSIONS
  This study revealed that 66.9% of PBC cases could be diagnosed based on trimmed bile ducts alone. Bile duct injury similar to that in PBC could be encountered in AIH.
authors.affiliation: Department of Human Pathology, Kanazawa University Graduate School of Medicine, Kanazawa, 920-8640, Japan.
authors.forename: Yoh
authors.initials: Y
authors.lastname: Zen
authors.forename: Kenichi
authors.initials: K
authors.lastname: Harada
authors.forename: Motoko
authors.initials: M
authors.lastname: Sasaki
authors.forename: Koichi
authors.initials: K
authors.lastname: Tsuneyama
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Matsui
authors.forename: Joji
authors.initials: J
authors.lastname: Haratake
authors.forename: Shotaro
authors.initials: S
authors.lastname: Sakisaka
authors.forename: Shiro
authors.initials: S
authors.lastname: Maeyama
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Yamamoto
authors.forename: Masayuki
authors.initials: M
authors.lastname: Nakano
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Shimamatsu
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Kage
authors.forename: Nozomu
authors.initials: N
authors.lastname: Kurose
authors.forename: Akio
authors.initials: A
authors.lastname: Uchiyama
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Kaizaki
authors.forename: Gotaro
authors.initials: G
authors.lastname: Toda
authors.forename: Yasuni
authors.initials: Y
authors.lastname: Nakanuma
mesh_terms: D001652:Bile Ducts / Q000473:pathology*; D005260:Female; D019693:Hepatitis, Autoimmune / Q000453:epidemiology / Q000473:pathology*; D006521:Hepatitis, Chronic / Q000453:epidemiology / Q000473:pathology*; D006525:Hepatitis, Viral, Human / Q000453:epidemiology / Q000473:pathology*; D006801:Humans; D008105:Liver Cirrhosis, Biliary / Q000453:epidemiology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation