Observer variation in assessment of liver biopsies including analysis by kappa statistics

Theodossi, A; Skene, A. M.; Portmann, B; Knill‐Jones, R. P.; Patrick, R. S.; Tate, R.A.; Kealey, William David; Jarvis, Karl J.; O'Brian, D.J.; Williams, Roger

doi:10.1016/0016-5085(80)90135-3

Cited by 110 publications

(39 citation statements)

References 8 publications

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“…The degree of the scoring changes for fibrosis and HAI were 2 or more points in the vast majority of specimens, and such differences have been shown to be highly reproducible by one or more observers [19,21,23]. These aspects of our study enhance confidence in the observations that fibrosis can commonly improve during corticosteroid treatment, but future studies are necessary to validate the conventional clinical assessments of fibrosis against noninvasive assays reflective of extracellular matrix proteins and/or hepatic stellate cell activity [13].…”

Section: Discussionmentioning

confidence: 51%

Decreased fibrosis during corticosteroid therapy of autoimmune hepatitis

Czaja

Carpenter

2004

Journal of Hepatology

217

136

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Section: Discussionmentioning

confidence: 51%

Decreased fibrosis during corticosteroid therapy of autoimmune hepatitis

Czaja

Carpenter

2004

Journal of Hepatology

217

136

View full text Add to dashboard Cite

“…The first can certainly be improved by clearly defined requirements for cutting and staining of biopsy samples and application of morphometric methods 3738 Making a histological diagnosis from different single features is a somewhat subjective integrating process which is influenced by an individual’s expertise 39. The decision making process for a diagnosis may also be influenced by the clinical data known to the pathologist.…”

Section: Discussionmentioning

confidence: 99%

Rectal biopsy for diagnosis of intestinal neuronal dysplasia in children: a prospective multicentre study on interobserver variation and clinical outcome

Koletzko¹,

Jesch

Faus-Kessler

et al. 1999

Gut

105

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Background-Intestinal neuronal dysplasia (IND) of the colonic submucous plexus is considered to be a congenital malformation of the enteric nervous system causing symptoms resembling those of Hirschsprung's disease. In contrast with the established diagnosis of aganglionosis using enzyme histochemistry, controversy exists over the diagnostic criteria of IND on rectal biopsies previously defined by a consensus report and the causal relation between morphological findings and clinical symptoms. Aims-The interobserver variability was prospectively investigated with respect to final diagnoses and several histological features in rectal biopsy specimens from children suspected of having colonic motility disturbances. Methods-377 biopsy specimens from 108 children aged 4 days to 15 years were independently coded without knowledge of clinical symptoms by three experienced pathologists for 20 histological features, and a final diagnosis was given for every case. Interobserver variation for the different items and the final diagnosis were analysed using Cohen's statistic. Clinical data at biopsy and outcome after 12 months were related to morphological findings. Results-The three pathologists agreed completely with respect to the diagnosis Hirschsprung's disease ( = 1), but in only 14% of the children without aganglionosis. In 15 (17%) of the 87 children without aganglionosis, at least one pathologist judged the case as normal, while another diagnosed IND. values were close to the zero value expected by chance for the diagnoses normal and IND. Young age was related to the presence of several morphological features-for example, acetylcholine esterase staining and presence of giant ganglia. Children with chronic constipation diagnosed as having IND, given no other specific diagnosis by any of the pathologists, were significantly younger (median 8.8 months) and had a higher cure rate after one year (60%) than constipated patients considered by all observers to have no histological abnormalities (median 6.1 years, cure rate 23%).Conclusions-In contrast with Hirschsprung's disease, there is a high interobserver variation with regard to the diVerent morphological features and final diagnosis of IND, based on the criteria and conditions of the previous consensus report. The high frequency of histological "abnormalities" in young infants suggests that some of the features may represent a normal variant of postnatal development rather than a pathological process. Investigations using more refined and morphometric methods in rectal specimens from infants and children without bowel disease are needed to define the normal range of morphological appearance at diVerent ages. These preliminary data indicate that, with current knowledge, rectal biopsy for diagnostic purposes should only be performed in constipated children for diagnosis of Hirschsprung's disease. (Gut 1999;44:853-861)

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“…Second, histological evaluation of liver tissue is prone to bias [12–15]. In a study investigating human evaluation of liver steatosis in people revealed a high level of variability between human observation and standardized computer measurement.…”

Section: Introductionmentioning

confidence: 99%

Variation in fat content between liver lobes and comparison with histopathological scores in dairy cows with fatty liver

et al. 2017

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BackgroundThe assessment of a liver biopsy remains the gold standard for diagnosing and staging fatty liver in dairy cows, which is often necessary for diagnostic and research purposes. Accuracy of the diagnosis relays on the quality of the biopsy, the assumed representativeness of a small tissue sample for a disease process throughout the liver and accurate human evaluation of histologic specimens. The objective of the present study was to assess the distribution of triacylglycerol (TAG) infiltration throughout the parenchyma of livers with different degrees of fatty liver in dairy cows. In addition, histopathological scores from the corresponding specimens were compared to a quantitative measurement of TAG, as well as the agreement between two observers.MethodsThirty livers with different degrees of lipid infiltration were selected and 10 different locations throughout the liver were assessed. The TAG content was measured enzymatically, calculated in % or mg/g wet weight, and assigned to a scoring system. Corresponding tissue specimens were stained with hematoxylin-eosin (H&E) and Oil red O (ORO) for histopathological evaluation, using a scoring system.ResultsThe difference in TAG content between any locations was less than 2%. Based on the scoring system the TAG concentration was even distributed in 79.3% of the livers. Based on kappa statistics the agreement between two pathologists and staining technique in scoring histological specimens was moderate to fair.ConclusionsOverall the distribution of TAG throughout the liver and the accuracy of human evaluation of liver biopsies may lead to acceptable diagnoses for clinical purposes. Within the liver lobules a common pattern of lipid distribution depending on severity could be observed. For the staging of lipid infiltration for research projects, some degree of variation needs to be considered.

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Observer variation in assessment of liver biopsies including analysis by kappa statistics

Cited by 110 publications

References 8 publications

Decreased fibrosis during corticosteroid therapy of autoimmune hepatitis

Decreased fibrosis during corticosteroid therapy of autoimmune hepatitis

Rectal biopsy for diagnosis of intestinal neuronal dysplasia in children: a prospective multicentre study on interobserver variation and clinical outcome

Variation in fat content between liver lobes and comparison with histopathological scores in dairy cows with fatty liver

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