Jung Eun Sun, Lee Kyoungbun, Yu Eunsil, Kang Yun Kyung, Cho Mee-Yon, Kim Joon Mee, Moon Woo Sung, Jeong Jin Sook, Park Cheol Keun, Park Jae-Bok, Kang Dae Young, Sohn Jin Hee, Jin So-Young
Gastrointestinal Pathology Study Group of Korean Society of Pathologist, Seoul, Korea.
Department of Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
J Pathol Transl Med. 2016 May;50(3):190-6. doi: 10.4132/jptm.2016.03.01. Epub 2016 Apr 18.
The histomorphologic criteria for the pathological features of liver tissue from patients with non-alcoholic fatty liver disease (NAFLD) remain subjective, causing confusion among pathologists and clinicians. In this report, we studied interobserver agreement of NAFLD pathologic features and analyzed causes of disagreement.
Thirty-one cases of clinicopathologically diagnosed NAFLD from 10 hospitals were selected. One hematoxylin and eosin and one Masson's trichrome-stained virtual slide from each case were blindly reviewed with regard to 12 histological parameters by 13 pathologists in a gastrointestinal study group of the Korean Society of Pathologists. After the first review, we analyzed the causes of disagreement and defined detailed morphological criteria. The glass slides from each case were reviewed a second time after a consensus meeting. The degree of interobserver agreement was determined by multi-rater kappa statistics.
Kappa values of the first review ranged from 0.0091-0.7618. Acidophilic bodies (k = 0.7618) and portal inflammation (k = 0.5914) showed high levels of agreement, whereas microgranuloma (k = 0.0984) and microvesicular fatty change (k = 0.0091) showed low levels of agreement. After the second review, the kappa values of the four major pathological features increased from 0.3830 to 0.5638 for steatosis grade, from 0.1398 to 0.2815 for lobular inflammation, from 0.1923 to 0.3362 for ballooning degeneration, and from 0.3303 to 0.4664 for fibrosis.
More detailed histomorphological criteria must be defined for correct diagnosis and high interobserver agreement of NAFLD.
非酒精性脂肪性肝病（NAFLD）患者肝组织病理特征的组织形态学标准仍具有主观性，这在病理学家和临床医生中造成了困惑。在本报告中，我们研究了NAFLD病理特征的观察者间一致性，并分析了不一致的原因。
从10家医院选取31例经临床病理诊断为NAFLD的病例。韩国病理学家协会胃肠研究组的13名病理学家对每个病例的一张苏木精-伊红染色和一张马松三色染色虚拟切片进行了盲法评估，涉及12个组织学参数。首次评估后，我们分析了不一致的原因并确定了详细的形态学标准。在一次共识会议后，对每个病例的玻片进行了第二次评估。观察者间一致性程度通过多评分者kappa统计量确定。
首次评估的kappa值范围为0.0091 - 0.7618。嗜酸性小体（k = 0.7618）和门管区炎症（k = 0.5914）显示出较高的一致性，而微肉芽肿（k = 0.0984）和微泡性脂肪变（k = 0.0091）显示出较低的一致性。第二次评估后，四项主要病理特征的kappa值分别为：脂肪变性分级从0.3830增至0.5638，小叶炎症从0.1398增至0.2815，气球样变性从0.1923增至0.3362，纤维化从0.3303增至0.4664。
必须定义更详细的组织形态学标准，以实现NAFLD的正确诊断和较高的观察者间一致性。
