Schiano Thomas D, Azeem Samia, Bodian Carol A, Bodenheimer Henry C, Merati Sukma, Thung Swan N, Hytiroglou Prodromos
Division of Liver Diseases, The Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY 10029, USA.
Clin Gastroenterol Hepatol. 2005 Sep;3(9):930-5. doi: 10.1016/s1542-3565(05)00541-0.
BACKGROUND & AIMS: In patients with chronic hepatitis C (CHC), percutaneous needle liver biopsy examination establishes the severity of necroinflammatory activity and fibrosis, thus guiding treatment decisions. Optimal biopsy specimen size remains controversial. We sought to determine how varying lengths of biopsy specimens influence the grading and staging of CHC.
We used 100 liver biopsy specimens from patients with CHC. The slides were evaluated blindly using the METAVIR scoring system, after being covered with paper, so that only specific specimen lengths (5 mm, 10 mm, 15 mm, and > or =20 mm) were visible. In each case, the scores obtained with biopsies 5 mm, 10 mm, or 15 mm long were compared with the scores at 20 mm or greater by weighted kappa statistics (kappa of >.75 signified excellent agreement). A subset of specimens 20 mm or greater was selected for a blinded repeat scoring to assess intraobserver agreement. The kappa statistics for the designated features and lengths were compared using analysis of variance.
In assessing the stage of fibrosis, the weighted kappa statistics for agreement with the 20-mm or greater score at 5 mm, 10 mm, and 15 mm were .75, .85, and .92, respectively. In assessing the histologic activity score, the corresponding figures were .73, .81, and .77, respectively. Average kappa statistic comparisons showed that intraobserver agreement was significantly better than agreement between the 20-mm or greater scores and those at shorter lengths; the 5-mm kappa scores were significantly lower than the others; and there was no significant difference between the 10-mm and 15-mm kappa scores.
Liver biopsy specimens measuring at least 10 mm usually reflect the grade and stage of CHC reliably. Relatively little improvement in diagnostic accuracy is obtained with longer specimens.
在慢性丙型肝炎（CHC）患者中，经皮肝穿刺活检可确定坏死性炎症活动和纤维化的严重程度，从而指导治疗决策。最佳活检标本大小仍存在争议。我们旨在确定不同长度的活检标本如何影响CHC的分级和分期。
我们使用了100例CHC患者的肝活检标本。玻片用纸覆盖后，采用METAVIR评分系统进行盲法评估，使得仅可见特定标本长度（5mm、10mm、15mm和≥20mm）。在每种情况下，通过加权kappa统计量（kappa>.75表示一致性极佳）将5mm、10mm或15mm长的活检标本所获评分与20mm及更长标本的评分进行比较。选择20mm及更长的一部分标本进行盲法重复评分，以评估观察者内一致性。使用方差分析比较指定特征和长度的kappa统计量。
在评估纤维化分期时，5mm、10mm和15mm长度标本与20mm及更长标本评分的加权kappa统计量分别为.75、.85和.92。在评估组织学活动评分时，相应数字分别为.73、.81和.77。平均kappa统计量比较显示，观察者内一致性显著优于20mm及更长标本评分与较短长度标本评分之间的一致性；5mm的kappa评分显著低于其他评分；10mm和15mm的kappa评分之间无显著差异。
至少10mm的肝活检标本通常能可靠地反映CHC的分级和分期。更长的标本在诊断准确性上的提高相对较小。
