Interobserver agreement on pathologic features of liver biopsy tissue in patients with nonalcoholic fatty liver disease

Eun Sun Jung, Kyoungbun Lee, Eunsil Yu, Yun Kyung Kang, Mee Yon Cho, Joon Mee Kim, Woo Sung Moon, Jin Sook Jeong, Cheol Keun Park, Jae Bok Park, Dae Young Kang, Jin Hee Sohn, So Young Jin

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24 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)190-196
Number of pages7
JournalJournal of Pathology and Translational Medicine
Issue number3
Publication statusPublished - 2016

Bibliographical note

Publisher Copyright:
© 2016 The Korean Society of Pathologists/The Korean Society for Cytopathology.

All Science Journal Classification (ASJC) codes

  • Pathology and Forensic Medicine
  • Histology


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