Viral Hepatitis
Copyright ©2006 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Mar 21, 2006; 12(11): 1713-1717
Published online Mar 21, 2006. doi: 10.3748/wjg.v12.i11.1713
Inter-observer variability in histopathological assessment of liver biopsies taken in a pediatric open label therapeutic program for chronic HBV infection treatment
Marek Woynarowski, Joanna Cielecka-Kuszyk, Andrzej Kałużyński, Aleksandra Omulecka, Maria Sobaniec-Łotowska, Julian Stolarczyk, Wojciech Szczepański
Marek Woynarowski, Department of Gastroenterology, Hepatology and Immunology, Children’s Health Memorial Institute, Warsaw, Poland
Joanna Cielecka-Kuszyk, Department of Pathology, Children’s Health Memorial Institute, Warsaw, Poland
Andrzej Kałużyński, Department of Pathology, Polish Mother Memorial Research Institute, Łódź, Poland
Aleksandra Omulecka, Department of Pathology, Medical University of Łódź, Poland
Maria Sobaniec-Łotowska, Department of Clinical Pathology, Medical University of Białystok, Poland
Julian Stolarczyk, Department of Pathology, Medical Academy of Gdańsk, Poland
Wojciech Szczepański, Department of Pathology, Jagiellonian University Medical College, Kraków, Poland
Correspondence to: Marek Woynarowski, MD, PhD, Department of Gastroenterology, Hepatology and Immunology, Children’s Health Memorial Institute, Al. Dzieci Polskich 20, 04-730 Warsaw, Poland.
Telephone: +48-502-236654 Fax: +48-22-8157382
Received: October 20, 2005
Revised: November 8, 2005
Accepted: November 18, 2005
Published online: March 21, 2006

AIM: To our knowledge, the inter-observer variability of the liver biopsy findings in HBV-infected children have not been studied as yet. Hence, we aimed to compare different pathologist’s assessment of grading and staging in liver biopsies obtained from children prior to interferon treatment.

METHODS: We collected 920 biopsies from 11 medical centers. The biopsies were independently reviewed by 6 pathologists from academic centers who assessed Batts-Ludwig score for grading and staging. Satisfactory agreement among observers was defined as at least 60% of observers having the same opinion. Satisfactory dispersion between maximal and minimal score for the same biopsy specimen was defined as a maximum 1 point.

RESULTS: Satisfactory inter-observer agreement for grading was obtained in 51.6% and for staging in 75.7% of biopsies. Satisfactory dispersion for grading scores was observed in 44.5% and for staging in 72.7% of cases.

CONCLUSION: Our study demonstrates that: (1) pathologists differ in their assessment of grading and staging of liver biopsies; (2) inter-observer variability for staging is lower than that for grading; and (3) regardless of the inter-observer variability of assessments, the majority of children with chronic HBV infection have mild to moderate inflammation and mild to moderate fibrosis.

Keywords: Grading, Staging, Type B Hepatitis, Children