Application of a new histological staging and grading system for primary biliary cirrhosis to liver biopsy specimens: Interobserver agreement |
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| Authors: | Yasuni Nakanuma Yoh Zen Kenichi Harada Motoko Sasaki Akitaka Nonomura Takeshi Uehara Kenji Sano Fukuo Kondo Toshio Fukusato Koichi Tsuneyama Masahiro Ito Kenichi Wakasa Minoru Nomoto Hiroshi Minato Hironori Haga Masayoshi Kage Hirohisa Yano Joji Haratake Shinichi Aishima Tomoyuki Masuda Hajime Aoyama Aya Miyakawa‐Hayashino Toshiharu Matsumoto Hayato Sanefuji Hidenori Ojima Tse‐Ching Chen Eunsil Yu Ji‐Hun Kim Young Nyun Park Wilson Tsui |
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| Affiliation: | 1. Department of Human Pathology, Kanazawa University Graduate School of Medicine,;2. Diagnostic Pathology Section, Kanazawa University Hospital,;3. Department of Diagnostic Pathology, Nara Medical University Hospital, Kashihara City,;4. Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto,;5. Department of Pathology, Teikyo University School of Medicine,;6. Department of Diagnostic Pathology, Toyama University School of Medicine, Toyama,;7. Department of Pathology, Nagasaki Medical Center, Omura,;8. Department of Diagnostic Pathology, Osaka City University Graduate School of Medicine, Osaka,;9. Department of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata,;10. Department of Pathology and Laboratory Medicine, Kanazawa Medical University, Kanazawa,;11. Department of Diagnostic Pathology, Hokkaido University Hospital, Sapporo,;12. Department of Pathology, Kurume University Hospital,;13. Department of Pathology, Kurume University School of Medicine, Kurume,;14. Department of Diagnostic Pathology, Saiseikai Yahata General Hospital,;15. Department of Pathological Sciences, Kyushu University Graduate School of Medical Sciences, Fukuoka,;16. Department of Pathology, School of Medicine, Iwate Medical University, Morioka,;17. First Department of Internal Medicine, Faculty of Medicine, University of the Ryukyu, Naha,;18. Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan,;19. Department of Diagnostic Pathology, Juntendo University Nerima Hospital,;20. Department of Pathology, Kitakyushu General Hospital, Kitakyushu,;21. Pathology Division, National Cancer Center, Tokyo,;22. Department of Pathology, Chang Gung Medical Center, Taipei, Taiwan,;23. Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center,;24. Department of Pathology, Yonsei University College of Medicine, Seoul, Korea and;25. Department of Pathology, Caritas Medical Centre, Hong Kong |
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| 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. |
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| Keywords: | cholangitis fibrosis hepatitis primary biliary cirrhosis staging and grading |
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