Zm. Younossi et al., Agreement in pathologic interpretation of liver biopsy specimens in posttransplant hepatitis C infection, ARCH PATH L, 123(2), 1999, pp. 143-145
Citations number
10
Categorie Soggetti
Research/Laboratory Medicine & Medical Tecnology","Medical Research Diagnosis & Treatment
Hepatitis C virus-related disease is rapidly becoming the most common indic
ation for orthotopic liver transplant (OLT) in the United States. Although
post-OLT hepatitis C viremia is universal, 40% to 60% of patients develop r
ecurrent chronic hepatitis C. Distinguishing recurrent chronic hepatitis C
infection from acute rejection may be difficult because of overlapping hist
opathologic features. To improve our diagnostic accuracy we undertook a stu
dy to determine interobserver and intraobserver agreement between pathologi
sts examining post-OLT liver biopsy specimens in patients from our transpla
nt database. Clinical data and microscopic sections from 26 patients with h
epatitis C virus-related OLT were reviewed. Biopsy specimens were obtained
because of abnormal liver enzymes (21/26) or routine post-OLT follow-up (5/
26), representing both early (18 +/- 11 days) and late (252 +/- 206 days) p
ost-OLT periods. Unidentified sections were examined by an experienced path
ologist in a randomly assigned order and reexamined 6 weeks later in the sa
me fashion by the initial reviewer and a second experienced pathologist. In
terobserver and intraobserver agreement was calculated using kappa statisti
c. The intraobserver agreement was 81% with a kappa coefficient of 0.67 (P
= .001). The interobserver agreement was 78% with a kappa coefficient of 0.
60 (P < .001). The early post-OLT biopsy specimens (18 +/- 11 days) were th
e most difficult to interpret.