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
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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.