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Can reference images improve interobserver agreement in reporting liver fibrosis?
  1. Alyn L German1,
  2. Kenneth Fleming2,
  3. Philip Kaye3,
  4. Susan Davies4,
  5. Robert Goldin5,
  6. Stefan G Hubscher6,
  7. Dina Tiniakos7,8,
  8. Angus McGregor9,
  9. Judith I Wyatt1
  1. 1Department of Histopathology, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, UK
  2. 2Green Templeton College, Oxford University, Oxford, UK
  3. 3Department of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, UK
  4. 4Department of Pathology, Cambridge University Hospitals NHS Trust, Cambridge, UK
  5. 5Centre for Pathology, Imperial College, London, UK
  6. 6Department of Histopathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  7. 7Faculty of Medical Sciences, Institute of Cellular Medicine, Newcastle University, Newcastle, UK
  8. 8Department of Histopathology, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
  9. 9Department of Histopathology, University Hospitals of Leicester NHS Trust, Leicester, UK
  1. Correspondence to Dr Alyn L German, Department of Histopathology, St James University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK; alyn.german{at}nhs.net

Abstract

Staging of fibrosis in medical liver biopsies has inherent interobserver variability. There are a number of disease-specific scoring systems available. While recognising the importance of these scoring systems, there is scope to consider how concordance amongst histopathologists could be improved using a generic fibrosis staging system.

Using virtual slides, we approached both specialist liver histopathologists and general histopathologists from the UK to assess the degree of fibrosis against a proposed four-tiered reporting system. Example reference images were then produced and distributed to the same responders who were asked to rate a second set of slides to assess if the use of reference images improved concordance between pathologists.

The use of reference images eliminated spread across three categories (from 15% to 0%). Overall, agreement was already good; our study showed an improved agreement amongst all participants for percentage agreement (67.79% to 70.08%) and interobserver agreement improved (Fleiss’ Kappa 0.55 to 0.59).

  • liver disease
  • fibrosis
  • histopathology
  • liver

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Footnotes

  • Handling editor Runjan Chetty

  • Contributors JIW and KF: initial concept for project. JIW, KF, PK, RG, SD, SGH, DT and AM: contributed to the development of the project and part one participants. PK: provided slides for assessment. JIW, KF and ALG: recruited participants. ALG and JIW: coordinated virtual slides, data collection and distribution and authored the manuscript. PK, KF, SD, RG, SGH, DT and AM: reviewed and edited the manuscript. ALG, JIW, KF, PK, RG, SD, SGH, DT and AM: responded to reviewer comments and revised manuscript.

  • Competing interests None declared.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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