Inter-observer and Intra-observer Agreement in Pathological Evaluation of Non-alcoholic Fatty Liver Disease Suspected Liver Biopsies

Abstract

Background:Histopathologic assessment of liver tissue is an essential step in management and follow-up of non-alcoholic fatty liver disease (NAFLD) while inter- and intra-observer variations limit the accuracy of these assessments.Objectives:The aim of this study was to assess the inter- and intra-observer reproducibility of histopathologic assessment of liver biopsies based on NAFLD activity score (NAS) scoring system.Materials and Methods:The anonymous liver biopsy samples of 100 consecutive NAFLD suspected adults were randomly assigned to four pathologists. Then, the samples were randomly reassigned to the pathologists for the second time in a way that each sample would be evaluated by two different pathologists. Biopsies were revisited by their first evaluator after two months. The results were reported based on NAS scoring system.Results:Inter-observer agreement of the pathology scores based on NAS scoring system was acceptable for steatosis, lobular inflammation, and fibrosis, but not for hepatocyte ballooning. The intra-observer agreement was acceptable in all scales, with lowest intra-class correlation observed for lobular inflammation.Conclusions:NAS scoring system has good overall inter- and intra-observer agreement, but more attention should be given to defining the hepatocyte ballooning and lobular inflammation, and training the pathologists to improve the accuracy of pathology reports.

Reliability of diagnosis from Mohs slides: interpersonal and intrapersonal agreement on basal cell carcinoma presence and histological subtype

“…Reliability of interpretation of Mohs slides is pivotal because the success of MMS depends mainly on the correct diagnosis of slides. This study showed substantial interpersonal and intrapersonal agreement on whether BCC was present and moderate agreement on BCC subtype, which is comparable with other fields of diagnostic reliability such as breast pathology and radiology . Discordant diagnosis on BCC presence was more frequent when slides were self‐scored as difficult to diagnose.…”

“…This study showed substantial interpersonal and intrapersonal agreement on whether BCC was present and moderate agreement on BCC subtype, which is comparable with other fields of diagnostic reliability such as breast pathology and radiology. [8][9][10][11][12][13][14][15][16] Discordant diagnosis on BCC presence was more frequent when slides were self-scored as difficult to diagnose. This suggests that raters are aware of their uncertainty and should know when to consult others to reduce misinterpretation.…”

Green Tea in Non-Alcoholic Fatty Liver Disease: A Double Blind Randomized Clinical Trial

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A scoring system for the diagnosis of non-alcoholic steatohepatitis from liver biopsy

“…High activity grade means the current status of hepatic injury and stage of fibrosis predict the progression of liver disease. The FLIP algorithm uses ballooning change and lobular inflammation as diagnostic factors but not fibrosis, which is used to assess the severity of NASH [10].…”

“…After consensus, five cases were classified as 'not-NASH' (case Nos. 21,2,11,12,and 10) by more than 50% of pathologists and 22 cases were classified as 'borderline' or 'NASH' by more than 50% of pathologists. The remaining four cases (case Nos.…”