El-Badry Ashraf Mohammad, Breitenstein Stefan, Jochum Wolfram, Washington Kay, Paradis Valérie, Rubbia-Brandt Laura, Puhan Milo A, Slankamenac Ksenija, Graf Rolf, Clavien Pierre-Alain
Department of Surgery, Swiss Hepato-Pancreatico-Biliary Center, University Hospital of Zurich, Zurich 8091, Switzerland.
Ann Surg. 2009 Nov;250(5):691-7. doi: 10.1097/SLA.0b013e3181bcd6dd.
The presence of fat in the liver is considered a major risk for postoperative complication after liver surgery and transplantation. The current standard of quantification of hepatic steatosis is microscopic evaluation by pathologists, although consistency in such assessment remains unclear. Computerized image analysis is an alternative method for objective assessment of the degree of hepatic steatosis.
High resolution images of hematoxylin and eosin stained liver sections from 46 consecutive patients, initially diagnosed with liver steatosis, were blindly assessed by 4 established expert pathologists from different institutions. Computerized analysis was carried out simultaneously on the same sections. Interobserver agreement and correlation between the pathologists' and computerized assessment were evaluated using intraclass correlation coefficients (ICC), Spearman rank correlation coefficients, or descriptive statistics.
Poor agreement among pathologists (ICC: 0.57) was found regarding the assessment of total steatosis, (ICC >0.7 indicates acceptable agreement). Pathologists' estimation of micro- and macrosteatosis disclosed also poor correlation (ICC: 0.22, 0.55, respectively). Inconsistent assessment of histological features of steatohepatitis (lobular inflammation, portal inflammation, hepatocyte ballooning, and Mallory hyaline) was documented. Poor conformity was also shown between the computerized quantification and ratings of 3 pathologists (Spearman rank correlation coefficients: 0.22, 0.82, 0.28, and 0.38).
Quantification of hepatic steatosis in histological sections is strongly observer-dependent, not reproducible, and does not correlate with the computerized estimation. Current standards of assessment, previously published data and the clinical relevance of hepatic steatosis for liver surgery and transplantation must be challenged.
肝脏中脂肪的存在被认为是肝脏手术和移植术后发生并发症的主要风险。目前肝脂肪变性的量化标准是由病理学家进行显微镜评估，尽管这种评估的一致性尚不清楚。计算机图像分析是客观评估肝脂肪变性程度的另一种方法。
4位来自不同机构的资深专家病理学家对46例最初诊断为肝脂肪变性的患者的苏木精-伊红染色肝脏切片的高分辨率图像进行了盲法评估。同时对相同切片进行计算机分析。使用组内相关系数（ICC）、Spearman等级相关系数或描述性统计来评估观察者之间的一致性以及病理学家评估与计算机评估之间的相关性。
病理学家在总脂肪变性评估方面的一致性较差（ICC：0.57），（ICC>0.7表示可接受的一致性）。病理学家对微脂肪变性和大脂肪变性的估计也显示出较差的相关性（ICC分别为0.22和0.55）。有记录表明，对脂肪性肝炎的组织学特征（小叶炎症、门管区炎症、肝细胞气球样变和马洛里小体）的评估不一致。计算机量化与3位病理学家的评级之间也显示出较差的一致性（Spearman等级相关系数分别为0.22、0.82、0.28和0.38）。
组织学切片中肝脂肪变性的量化在很大程度上依赖于观察者，不可重复，且与计算机估计不相关。必须对目前的评估标准、先前发表的数据以及肝脂肪变性对肝脏手术和移植的临床相关性提出质疑。
