Determination of Interobserver Correlation in the Evaluation of Liver Histopathology of Chronic Hepatitis B Patients and the Reflections on Treatment

Abstract

Objective: Histopathological examination of the liver is the gold standard in the follow-up and treatment of chronic hepatit B vius (HBV) disease. Ishak's Modified histological activity index (HAI) and fibrosis staging system are usually used in Turkey. Although a common scoring system is used, the same sample can be interpreted differently between different pathologists due to various variables. In this study, the evaluation of liver histopathologies of chronic HBV patients by pathologists in different hospitals and the correlation of the results with each other and the effect on the treatment decision were investigated. Methods: Pathology slides of liver biopsy materials of 10 patients were evaluated by pathologists in 5 different tertiary care hospitals. Using non-parametric statistical methods, the coefficient of agreement between pathologists was determined. Also, descriptive statistics were used to determine the percentage of receiving treatment. Results: Agreement between pathologists was calculated the most in total HAI and Fibrosis score (k=0.8186, k=0.8217). The Kuder-Richardson reliability coefficient among centres was found to be high in the treatment decision (k=0.8207). Although all patients were indicated for treatment according to The European Association for the Study of the Liver 2017 guideline, it was calculated that an average of 58% of the patients could receive treatment according to liver histopathology. Conclusion: Differences in the pathological diagnosis between pathologists in centres may cause delays in chronic hepatitis B patients' access to treatment.