INTEROBSERVER AGREEMENT IN THE HISTOLOGIC SCORING OF CHRONIC VIRAL HEPATITIS

Abstract

Various scoring systems are used in histological assessment of chronic viral hepatitis. The aim of this study is to investigate the interobserver agreement in METAVIR, Batts-Ludwig and modified Knodell scoring systems and the system we use in the evaluation of HCV hepatitis in our unit. Seventynine liver core biopsies of HBV and HCV hepatitis patients were included in this study. The slides were retrieved from the archieve and scored by two observers according to the scoring systems mentioned above. Kappa statistics were used to evaluate the interobserver agreement. The liver biopsies of 43 (54.4%) HBV, 36 (45.6%) HCV hepatitis patients were investigated. The kappa scores ranged between 0.26 and 0.65 in the hepatitis activity (grading) evaluations. The highest kappa score was observed in Batts-Ludwig system. The kappa scores ranged from 0.33 to 0.67 in the fibrosis (staging) evaluations. The highest kappa score was obtained from METAVIR system. The number of portal areas the biopsy contained was found to be a factor affecting the kappa scores in the positive way. We concluded that the simpler the scoring system used, the higher the kappa score, and suggest that it was found to be more practical to use a simple and visual system which has a better interobserver agreement, in the routine practice. It is important to describe the lesions as well as scoring them for the reproducibility of the evaluation for future reference.