Presented in part at the 21st European Association for the Study of the Liver, Groningen, The Netherlands, September 3–6, 1986.
Observer Variation in Assessment of Liver Biopsies of Alcoholic Patients
Article first published online: 11 APR 2006
Alcoholism: Clinical and Experimental Research
Volume 12, Issue 1, pages 173–178, February 1988
How to Cite
Bedossa, P., Poynard, T., Naveau, S., Martin, E. D., Agostini, H. and Chaput, J. C. (1988), Observer Variation in Assessment of Liver Biopsies of Alcoholic Patients. Alcoholism: Clinical and Experimental Research, 12: 173–178. doi: 10.1111/j.1530-0277.1988.tb00155.x
- Issue published online: 11 APR 2006
- Article first published online: 11 APR 2006
- Received for publication May 18, 1987; revised manuscript received July 30, 1987; accepted August 4, 1987.
The aim was to construct a questionnaire analyzing pathological features possibly present in alcoholic liver disease, to assess its interobserver variation and to determine the influence of technical data on this variation. A total of 764 inpatients drinking 90 g (median) of pure alcohol per day for 25 years was observed; 402 patients were excluded because of associated nonalcoholic disease, refusal or contraindication to biopsy, leaving 362 patients included. Two pathologists independently analyzed each biopsy and completed a questionnaire including 41 items. Coefficient of concordance between observers was evaluated with the kappa statistic (κ). The prevalence of 14 lesions was low, equal to or under 10%, leading to a nonsignificant concordance. For the 27 remaining features, two had an almost perfect degree of concordance (κ > 0.81): presence of hepatocellular carcinoma and cirrhosis. Three had a substantial coefficient of concordance (κ > 0.61): fibrous septa, size of cirrhotic nodules, and liver cell regeneration. Nine had a moderate (κ > 0.41), 11 a fair (κ > 0.21), and two a slight (κ < 0.21) coefficient of concordance. In terms of final diagnosis of alcoholic liver disease the concordance was substantial for cirrhosis with acute alcoholic hepatitis (κ= 0.77), cirrhosis without alcoholic hepatitis (κ= 0.75), acute alcoholic hepatitis without cirrhosis (κ= 0.65) and normal liver (κ= 0.64). Concordance was moderate for steatosis (κ= 0.47) and slight for fibrosis alone (κ= 0.16). For technical data, there was a trend for a higher concordance for the plastic-embedded biopsies than for the paraffin-embedded (p < 0.08) and for the samples containing more than six portal tracts than for the smaller biopsy samples (p < 0.10). In conclusion interobserver variations suggest that assessment of liver biopsies in alcoholic liver disease has to be carefully performed, in duplicate using clear definitions and a simplified questionnaire, for clinical research.