Observer error in biopsy interpretations and outcome in chronic hepatitis
Kirschner, E.; Chalmers, T.C.; Popper, H.; Gerber, M.A.; Stenger, R.J.; Goldberg, J.D.; Sacks, H.
Mount Sinai Journal of Medicine new York 49(6): 472-474
1982
ISSN/ISBN: 0027-2507 PMID: 6984730 Document Number: 196463
To assess the effect of inter- and intra-observer error on the diagnosis of chronic hepatitis, liver biopsy slides from 30 patients whose biopsies were obtained > 5 yr ago were examined. Each slide was reviewed on 2 separate occasions, without knowledge of previous diagnoses, by 3 pathologists from 2 hospitals. Patient outcome was assessed using a telephone questionnaire. Intra-observer agreement ranged from 83-96%. The 2 pathologists from the same hospital agreed 90% of the time, but overall, the 3 pathologists disagreed on 27% of the slides (P < 0.01). Four of the original 30 diagnoses were unanimously reversed. This study confirms the benign prognosis of chronic persistent hepatitis compared to chronic active hepatitis but emphasizes that interobserver variability reduces the predictive value of a single biopsy report. This has serious implications with regard to choice of therapy.