特发性非肝硬化性门静脉高压症组织学特征的观察者间研究。
Interobserver study on histologic features of idiopathic non-cirrhotic portal hypertension.
机构信息
Department of Pathology, Albany Medical Center, 47 New Scotland Ave., MC81, Albany, NY, 12208, USA.
Department of Pathology, Columbia University, New York, NY, 10032, USA.
出版信息
Diagn Pathol. 2020 Oct 23;15(1):129. doi: 10.1186/s13000-020-01049-0.
BACKGROUND
Histologic features of idiopathic non-cirrhotic portal hypertension (INCPH) may overlap with those without INCPH. Recently, these features have been recognized as part of the larger spectrum of porto-sinusoidal vascular disease (PSVD). We assessed interobserver agreement on histologic features that are commonly associated with INCPH and studied whether a provision of relevant clinical history improves interobserver agreement.
METHODS
The examined histologic features include lobular (such as anisocytosis, nodular regeneration, sinusoidal dilatation, increased parenchymal draining veins, and incomplete fibrous septa) and portal tract changes (such as paraportal shunting vessel(s), portal tract remnant, increased number of portal vessels, and obliterative portal venopathy). Thirty-four archived liver samples from patients with (group A) and without (group B) INCPH were retrieved. A total of 90 representative images of lobules (L) and portal tracts (P) were distributed among 9 liver pathologists blinded to true clinical history. Each pathologist answered multiple choice questions based on the absence (Q1) or presence (Q2) of clinical history of portal hypertension. Fleiss' kappa coefficient analysis (unweighted) was performed to assess interobserver agreement on normal versus abnormal diagnosis, in L and P, based on Q1 and Q2.
RESULTS
The kappa values regarding normal versus abnormal diagnosis were 0.24, 0.24, 0.18 and 0.18 for L-Q1, L-Q2, P-Q1, and P-Q2, respectively. With true clinical history provided, the kappa values were L- 0.32, P-0.17 for group A and L-0.12, P-0.14 for group B. Four pathologists changed their assessments based on the provided history. Interobserver agreement on the interpretation of L and P as normal versus abnormal was slight to fair regardless of provision of clinical history.
CONCLUSIONS
Our findings indicate that the histologic features of INCPH/PSVD are not limited to patients with portal hypertension and are subject to significant interobserver variation.
背景
特发性非肝硬化性门静脉高压症（INCPH）的组织学特征可能与无 INCPH 的特征重叠。最近，这些特征被认为是门腔静脉血管疾病（PSVD）较大谱的一部分。我们评估了与 INCPH 常见的组织学特征的观察者间一致性，并研究了提供相关临床病史是否可以提高观察者间的一致性。
方法
所检查的组织学特征包括小叶（如大小不均、结节再生、窦状扩张、实质引流静脉增加和不完全纤维间隔）和门脉区改变（如门旁分流血管、门脉区残留、门脉血管数量增加和闭塞性门静脉病）。从 INCPH 患者（A 组）和无 INCPH 患者（B 组）中检索了 34 例存档的肝组织样本。9 位肝脏病理学家在不了解真实临床病史的情况下，将 90 张小叶（L）和门脉区（P）的代表性图像分配给每位病理学家。每位病理学家根据门脉高压的临床病史（Q1）或不存在（Q2）回答多项选择题。对 Q1 和 Q2 进行 Fleiss'kappa 系数分析（未加权），以评估基于 Q1 和 Q2 在 L 和 P 中正常与异常诊断的观察者间一致性。
结果
在 L-Q1、L-Q2、P-Q1 和 P-Q2 中，正常与异常诊断的 kappa 值分别为 0.24、0.24、0.18 和 0.18。提供真实临床病史后，A 组的 kappa 值为 L-0.32、P-0.17，B 组为 L-0.12、P-0.14。4 位病理学家根据提供的病史改变了他们的评估。无论提供临床病史与否，L 和 P 正常与异常的解释的观察者间一致性均为轻度至中度。
结论
我们的研究结果表明，INCPH/PSVD 的组织学特征不仅限于门静脉高压患者，而且存在显著的观察者间差异。
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