Banff fibrosis study: multicenter visual assessment and computerized analysis of interstitial fibrosis in kidney biopsies.
Increasing interstitial fibrosis (IF) in native and kidney transplant biopsies is associated with functional decline and serves as a clinical trial end point. A Banff 2009 Conference survey revealed a range in IF assessment practices. Observers from multiple centers were asked to assess 30 renal biopsies with a range of IF and quantitate IF using two approaches on trichrome, Periodic acid-Schiff (PAS) and computer-assisted quantification of collagen III immunohistochemistry (C-IHC) slides, as well as assessing percent of cortical tubular atrophy% (TA%) and Banff total cortical inflammation score (ti-score). C-IHC using whole slide scans was performed. C-IHC assessment showed a higher correlation with organ function (r = -0.48) than did visual assessments (r = -0.32--0.42); computerized and visual C-IHC assessment also correlated (r = 0.64-0.66). Visual assessment of trichrome and C-IHC showed better correlations with organ function and C-IHC, than PAS, TA% and ti-score. However, visual assessment of IF, independent of approach, was variable among observers, and differences in correlations with organ function were not statistically significant among C-IHC image analysis and visual assessment methods. C-IHC image analysis correlated among three centers (r > 0.90, p < 0.0001, between all centers). Given the difficulty of visual IF assessment standardization, C-IHC image could potentially accomplish standardized IF assessment in multicenter settings.
Department of Pathology, Emory University, Atlanta, GA.
A B
AB
Farris
S
S
Chan
J
J
Climenhaga
B
B
Adam
C O C
CO
Bellamy
D
D
Serón
R B
RB
Colvin
J
J
Reeve
M
M
Mengel
D001706:Biopsy; D024061:Collagen Type III / Q000378:metabolism*; D005355:Fibrosis / Q000145:classification* / Q000378:metabolism / Q000473:pathology*; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007124:Immunoenzyme Techniques; D007684:Kidney Tubules / Q000378:metabolism / Q000473:pathology*; D015588:Observer Variation; D011379:Prognosis
D024061:Collagen Type III
Allograft monitoring; Banff schema; chronic graft deterioration; collagen; end points; fibrosis; graft function; image analysis; kidney; pathologist; pathology of renal transplantation