Goldin R D, Goldin J G, Burt A D, Dhillon P A, Hubscher S, Wyatt J, Patel N
Department of Histopathology, St. Mary's Hospital Medical School, London, UK.
J Hepatol. 1996 Nov;25(5):649-54. doi: 10.1016/s0168-8278(96)80234-0.
BACKGROUND/AIMS: The way in which liver biopsies showing chronic hepatitis are reported is undergoing re-evaluation. A related question is how the inflammatory and fibrotic changes in these liver biopsies can be semi-quantitatively assessed so that comparisons can be made between groups of patients and the effect of treatment on disease progression studied.
We have carried out a blinded trial in which 20 cases of chronic viral hepatitis were assessed by five histopathologists, using the Knodell and Scheuer scoring systems (two of the most commonly used systems), on two separate occasions. The results were analysed using Kappa statistics, and also by seeing for how many slides the pathologists showed no significant disagreement.
While both systems produced good inter- and intra-observer variation when fibrosis was assessed the Scheuer system produced slightly higher Kappa values. The Scheuer system produced considerably better agreement when the severity of inflammation was examined. A multirater kappa analysis confirmed that both systems showed better agreement for fibrosis scores than for inflammation scores.
We conclude that, while both systems produced reasonable agreement, this was greater using the Scheuer system. When any new scoring system is being developed, the question of reproducibility needs active consideration.
背景/目的：对显示慢性肝炎的肝活检报告方式正在进行重新评估。一个相关问题是，如何对这些肝活检中的炎症和纤维化变化进行半定量评估，以便能够在患者组之间进行比较，并研究治疗对疾病进展的影响。
我们进行了一项盲法试验，由五位组织病理学家使用Knodell和Scheuer评分系统（两种最常用的系统），在两个不同时间对20例慢性病毒性肝炎病例进行评估。使用Kappa统计分析结果，并观察病理学家对多少张切片没有显著分歧。
在评估纤维化时，两种系统都产生了良好的观察者间和观察者内差异，但Scheuer系统产生的Kappa值略高。在检查炎症严重程度时，Scheuer系统产生的一致性要好得多。多评分者kappa分析证实，两种系统在纤维化评分上的一致性都比炎症评分好。
我们得出结论，虽然两种系统都产生了合理的一致性，但使用Scheuer系统时一致性更高。在开发任何新的评分系统时，再现性问题都需要积极考虑。
