Anatomie Pathologique, AP-HP, Hôpital St Antoine, Paris, France; Sorbonne Universités, UPMC Université Paris 06, Paris, France.
Liver Int. 2015 Feb;35(2):652-9. doi: 10.1111/liv.12620. Epub 2014 Jul 8.
BACKGROUND & AIMS: A simple and reproducible evaluation of non diagnostic histological lesions related to prognosis remains crucial in primary biliary cirrhosis (PBC). Presently there is no satisfactory simple scoring system analysing them reliably. We elaborated a semi-quantitative scoring system that assesses fibrosis, lymphocytic interface hepatitis (LIH) and ductopenia, separately. This study was aimed to evaluate its intra/interobserver reproducibility and its correlation with the main biochemical data.
Liver biopsies from 33 consecutive newly diagnosed PBC patients were independently analysed by five liver pathologists. Fibrosis was classified into five stages (portal/periportal fibrosis/few septa/numerous septa/cirrhosis) and LIH into four grades. The bile duct ratio (BDR), i.e. ratio of the number of portal tracts with ducts to total number of portal tracts, Ludwig's and Scheuer's stages were evaluated. Intra and interobserver agreements were assessed. Histological results were correlated to the biochemical data.
Most patients had an early disease on clinical and biological parameters. The biopsies measured 23 mm on average (range 12 - 40 mm). Intraobserver reproducibility was substantial for fibrosis (κ = 0.68), LIH (κ = 0.69) and BDR (ICC = 0.69). Interobserver agreement for fibrosis was fair with the 5-class system (κ = 0.36), moderate with a 4-class system (κ = 0.56). moderate for LIH (κ = 0.59) and BDR (ICC = 0.50). Ludwig's and Scheuer's staging showed a fair interobserver agreement (κ = 0.32, κ = 0.31 respectively). Our system showed better correlations with biochemistry than Ludwig's and Scheuer's systems did.
This simple scoring system, assessing fibrosis, LIH and BDR separately, has a substantial intraobserver and a moderate interobserver reproducibility. Its prognostic relevance has to be evaluated.
在原发性胆汁性肝硬化（PBC）中，对于非诊断性组织学病变与预后的关系，仍需要一种简单且可重复的评估方法。目前，尚无令人满意的简单评分系统能够可靠地对其进行分析。我们制定了一种半定量评分系统，分别评估纤维化、淋巴细胞性界面肝炎（LIH）和胆管减少。本研究旨在评估其观察者内和观察者间的可重复性，及其与主要生化数据的相关性。
33 例新诊断的 PBC 患者的连续肝活检标本由 5 位肝脏病理学家独立分析。纤维化分为 5 期（门管区/门管周围纤维化/少量间隔/大量间隔/肝硬化），LIH 分为 4 级。评估胆管比（BDR），即有胆管的门管区数与总门管区数之比、Ludwig 分期和 Scheuer 分期。评估了观察者内和观察者间的一致性。将组织学结果与生化数据相关联。
大多数患者的临床和生物学参数显示疾病处于早期阶段。活检标本平均长度为 23mm（范围 12-40mm）。纤维化（κ=0.68）、LIH（κ=0.69）和 BDR（ICC=0.69）的观察者内重复性较好。纤维化的 5 级系统观察者间一致性为一般（κ=0.36），4 级系统为中度（κ=0.56）。LIH（κ=0.59）和 BDR（ICC=0.50）的观察者间一致性为中度。Ludwig 分期和 Scheuer 分期的观察者间一致性为一般（κ=0.32，κ=0.31）。我们的系统与生物化学的相关性优于 Ludwig 分期和 Scheuer 分期。
这种单独评估纤维化、LIH 和 BDR 的简单评分系统，具有较好的观察者内和一般的观察者间可重复性。其预后相关性有待进一步评估。
