J Pathol Transl Med.  2016 May;50(3):190-196. 10.4132/jptm.2016.03.01.

Interobserver Agreement on Pathologic Features of Liver Biopsy Tissue in Patients with Nonalcoholic Fatty Liver Disease

• Jung ES
• Lee K
• Yu E
• Kang YK
• Cho MY
• Kim JM
• Moon WS
• Jeong JS
• Park CK
• Park JB
• Kang DY
• Sohn JH
• Jin SY

• KMID: 2164595
• DOI: http://doi.org/10.4132/jptm.2016.03.01

Abstract

BACKGROUND
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.
METHODS
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.
RESULTS
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.
CONCLUSIONS
More detailed histomorphological criteria must be defined for correct diagnosis and high interobserver agreement of NAFLD.

Keyword

Non-alcoholic fatty liver disease; Pathologic features; Interobserver agreement

MeSH Terms

Biopsy*
Consensus
Diagnosis
Eosine Yellowish-(YS)
Fibrosis
Glass
Hematoxylin
Humans
Inflammation
Liver*
Non-alcoholic Fatty Liver Disease*
Eosine Yellowish-(YS)
Hematoxylin

Figure

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  Fig. 1. Grading of steatosis. It is determined by fat volume rather than number of fatty hepatocytes. (A) <5%. (B) 5%–33%. (C) 34%–66%. (D) > 66%.

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  Fig. 2. Lobular inflammation. A focus spotty necrosis of hepatocytes (arrows), lymphocyte aggregation (arrowheads), and acidophilic bodies (asterisk) can be seen.

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  Fig. 3. Ballooning degeneration. (A) Group of enlarged round cells with loss of polygonal features and heterogeneous granular cytoplasm are noted. (B) Ballooning degeneration with cytoplasmic Mallory’s bodies (arrows) are found.

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  Fig. 4. Mimickers of ballooning degeneration. (A, B) Hydropic swelling and microvesicular fatty changes mimicking ballooning degeneration.

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  Fig. 5. Fibrosis around the central area (A), normal framework (B), normal range framework without pericelluar collagen deposition (C), and mild perisinusoidal fibrosis with definite pericellular collagen deposition.

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  Fig. 6. Microvesicular steatosis. (A) Microvesicular fatty changes including lipoblast-like features showing numerous intracytoplasmic micro-fat vacuoles with nuclear indentation (arrows). (B) Excluding small- or medium-sized fat vacuoles without cytoplasmic enlargement and nuclear indentation should not be confused with microvesicular steatosis.

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