Interobserver Variation in Grading and Staging of Chronic Hepatitis Using Knodell Ishak (Modified HAI) or Batts-Ludwig Scoring Systems

Document Type : Original Article (s)

Authors

1 Associate Professor, Department of Pathology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Professor, Department of Pathology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

3 Student of Medicine, School of Medicine AND Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Reliable assessment of liver histopathology in patients with chronic hepatitis is important for assessing the severity of the disease. This study aimed to survey the interobserver variability of liver biopsy assessment performed via two of the most commonly used systems.Methods: 54 liver biopsies from patients with chronic hepatitis were scored by three independent observers using Knodell Ishak [modified histology activity index (HAI)] and Batts-Ludwig systems.Findings: The best agreement was seen for Knodell Ishak’s staging (Kendall’s correlation coefficient (r) = 90%, P < 0.001). The worst agreement was seen for Batts-Ludwig grading. (r = 63%, P < 0.001).Conclusion: We conclude that both systems showed better agreement for staging than for grading; while both systems produced reasonable agreement between the observers, Knodell Ishak system showed greater results.

Keywords

References

  1. Fiel MI. Pathology of chronic hepatitis B and chronic hepatitis C. Clin Liver Dis 2010; 14(4): 555-75.
  2. Woynarowski M, Cielecka-Kuszyk J, Kaluzynski A, Omulecka A, Sobaniec-Lotowska M, Stolarczyk J, et al. Inter-observer variability in histopathological assessment of liver biopsies taken in a pediatric open label therapeutic program for chronic HBV infection treatment. World J Gastroenterol 2006; 12(11): 1713-7.
  3. Schaff Z. The value of liver biopsy in chronic hepatitis. Orv Hetil 2011; 152(22): 856-8. [In Hungarian].
  4. De Groote J, Desmet VJ, Gedigk P, Korb G, Popper H, Poulsen H, et al. A classification of chronic hepatitis. Lancet 1968; 2(7568): 626-8.
  5. Rosai J. Rosai and Ackerman's surgical pathology. 10th ed. Philadelphia, PA: Mosby; 2011. p. 857-981.
  6. Bedossa P, Bioulac-Sage P, Callord P, Chevallier M, Degott C, Deugnier Y, et al. Intraobserver and interobserver variations in liver biopsy interpretation in patients with chronic hepatitis C. The French METAVIR Cooperative Study Group. Hepatology 1994; 20(1 Pt 1): 15-20.
  7. Westin J, Lagging LM, Wejstal R, Norkrans G, Dhillon AP. Interobserver study of liver histopathology using the Ishak score in patients with chronic hepatitis C virus infection. Liver 1999; 19(3): 183-7.
  8. Gronbaek K, Christensen PB, Hamilton-Dutoit S, Federspiel BH, Hage E, Jensen OJ, et al. Interobserver variation in interpretation of serial liver biopsies from patients with chronic hepatitis C. J Viral Hepat 2002; 9(6): 443-9.
  9. Goodman ZD. Grading and staging systems for inflammation and fibrosis in chronic liver diseases. J Hepatol 2007; 47(4): 598-607.
  10. McMahon BJ, Bulkow L, Simons B, Zhang Y, Negus S, Homan C, et al. Relationship between level of hepatitis B virus DNA and liver disease: a population-based study of hepatitis B e antigen-negative persons with hepatitis B. Clin Gastroenterol Hepatol 2014; 12(4): 701-6.
  11. Abbasi A, Butt N, Bhutto AR, Munir SM, Dhillo AK. Liver histology of chronic hepatitis C patients who relapsed or not responded to conventional interferon and ribavirin therapy. J Pak Med Assoc 2013; 63(2): 231-3.
Journal of Isfahan Medical School
Volume 33, Issue 344 - Serial Number 344
May and June 2015
Pages 1211-1219

Files

History

  • Receive Date: 28 May 2014
  • Revise Date: 27 May 2024
  • Accept Date: 06 April 2022

Share

How to cite

Statistics