Application of a new histological staging and grading system for primary biliary cirrhosis to liver biopsy specimens: Interobserver agreement.
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.
Nakanuma
Yasuni
Y
Department of Human Pathology, Kanazawa University Graduate School of Medicine, Kanazawa 920-8640, Japan. pbcpsc@kenroku.kanazawau.ac.jp
Zen
Yoh
Y
Harada
Kenichi
K
Sasaki
Motoko
M
Nonomura
Akitaka
A
Uehara
Takeshi
T
Sano
Kenji
K
Kondo
Fukuo
F
Fukusato
Toshio
T
Tsuneyama
Koichi
K
Ito
Masahiro
M
Wakasa
Kenichi
K
Nomoto
Minoru
M
Minato
Hiroshi
H
Haga
Hironori
H
Kage
Masayoshi
M
Yano
Hirohisa
H
Haratake
Joji
J
Aishima
Shinichi
S
Masuda
Tomoyuki
T
Aoyama
Hajime
H
Miyakawa-Hayashino
Aya
A
Matsumoto
Toshiharu
T
Sanefuji
Hayato
H
Ojima
Hidenori
H
Chen
Tse-Ching
TC
Yu
Eunsil
E
Kim
Ji-Hun
JH
Park
Young Nyun
YN
Tsui
Wilson
W
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