title: Application of a new histological staging and grading system for primary biliary cirrhosis to liver biopsy specimens: Interobserver agreement.
abstract: 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.
authors.affiliation: Department of Human Pathology, Kanazawa University Graduate School of Medicine, Kanazawa 920-8640, Japan. pbcpsc@kenroku.kanazawau.ac.jp
authors.forename: Yasuni
authors.initials: Y
authors.lastname: Nakanuma
authors.forename: Yoh
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authors.lastname: Zen
authors.forename: Kenichi
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authors.lastname: Harada
authors.forename: Motoko
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authors.lastname: Sasaki
authors.forename: Akitaka
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authors.lastname: Nonomura
authors.forename: Takeshi
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authors.lastname: Uehara
authors.forename: Kenji
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authors.forename: Fukuo
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authors.forename: Toshio
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authors.lastname: Fukusato
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authors.lastname: Ito
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authors.lastname: Wakasa
authors.forename: Minoru
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authors.lastname: Nomoto
authors.forename: Hiroshi
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authors.lastname: Minato
authors.forename: Hironori
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authors.lastname: Haga
authors.forename: Masayoshi
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authors.lastname: Kage
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authors.lastname: Yano
authors.forename: Joji
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authors.lastname: Haratake
authors.forename: Shinichi
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authors.lastname: Aishima
authors.forename: Tomoyuki
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authors.lastname: Masuda
authors.forename: Hajime
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authors.lastname: Aoyama
authors.forename: Aya
authors.initials: A
authors.lastname: Miyakawa-Hayashino
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Matsumoto
authors.forename: Hayato
authors.initials: H
authors.lastname: Sanefuji
authors.forename: Hidenori
authors.initials: H
authors.lastname: Ojima
authors.forename: Tse-Ching
authors.initials: TC
authors.lastname: Chen
authors.forename: Eunsil
authors.initials: E
authors.lastname: Yu
authors.forename: Ji-Hun
authors.initials: JH
authors.lastname: Kim
authors.forename: Young Nyun
authors.initials: YN
authors.lastname: Park
authors.forename: Wilson
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authors.lastname: Tsui
mesh_terms: D000368:Aged; D001652:Bile Ducts / Q000473:pathology*; D002779:Cholestasis / Q000145:classification / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D005355:Fibrosis / Q000473:pathology; D006526:Hepatitis C / Q000145:classification / Q000473:pathology; D006801:Humans; D007249:Inflammation / Q000145:classification / Q000473:pathology; D008099:Liver / Q000473:pathology*; D008105:Liver Cirrhosis, Biliary / Q000145:classification* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation