Application of a new histological staging and grading system for primary biliary cirrhosis to liver biopsy specimens: Interobserver agreement

Yasuni Nakanuma, Yoh Zen, Kenichi Harada, Motoko Sasaki, Akitaka Nonomura, Takeshi Uehara, Kenji Sano, Fukuo Kondo, Toshio Fukusato, Koichi Tsuneyama, Masahiro Ito, Kenichi Wakasa, Minoru Nomoto, Hiroshi Minato, Hironori Haga, Masayoshi Kage, Hirohisa Yano, Joji Haratake, Shinichi Aishima, Tomoyuki MasudaHajime Aoyama, Aya Miyakawa-Hayashino, Toshiharu Matsumoto, Hayato Sanefuji, Hidenori Ojima, Tse Ching Chen, Eunsil Yu, Ji Hun Kim, Young Nyun Park, Wilson Tsui

Research output: Contribution to journalArticlepeer-review

168 Citations (Scopus)


Recently the authors proposed a new staging and grading system for primary biliary cirrhosis (PBC) that takes into account necroinflammatory activity and histological heterogeneity. Herein is proposed a convenient version of this system. Scores for fibrosis, bile duct loss, and chronic cholestasis were combined for staging: stage 1, total score of 0; stage 2, score 1-3; stage 3, score 4-6; and stage 4, score 7-9. Cholangitis activity (CA) and hepatitis activity (HA) were graded as CA0-3, and HA0-3, respectively. Analysis of interobserver agreement was then conducted. Digital images of 62 needle liver biopsy specimens of PBC were recorded as virtual slides on DVDs that were sent to 28 pathologists, including five located overseas. All participants were able to apply this version in all 62 cases. For staging, kappa was 0.385 (fair agreement) and the concordance rate was 63.9%. For necroinflammatory activity, the kappa and concordance rate were 0.110 (slight agreement) and 36.9% for CA, and 0.197 (slight agreement) and 47% for HA, respectively. In conclusion, this new staging and grading system for PBC seems to be more convenient and practical than those used at present, but more instruction and guidance are recommended for the grading of necroinflammatory activity in practice.

Original languageEnglish
Pages (from-to)167-174
Number of pages8
JournalPathology international
Issue number3
Publication statusPublished - 2010 Mar
Externally publishedYes


  • Cholangitis
  • Fibrosis
  • Hepatitis
  • Primary biliary cirrhosis
  • Staging and grading

ASJC Scopus subject areas

  • Pathology and Forensic Medicine


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