Histopatologicka diagnostika chronickych hepatitid.

Liver biopsy interpretation changed substantionally with the change of chronic hepatitis classification. Grading and staging of chronic hepatitis appears to be one of the most important tasks for liver biopsy. Conventional verbal approach does not seem to fulfill demands of precise and reproducible methods of evaluation mild forms of chronic hepatitis, mostly hepatitis C. There are many semiquantitative scoring systems for numeric grading and staging. These systems are used to initiate treatment and to compare different liver samples in an individual patient to follow and to manage the development of his/her disease as well as in large cohorts of patients in clinical trials. There is no consensus on the use of these systems. Scientific papers evaluating individual scoring systems are rare and papers evaluating and comparing different systems are extremely rare. Intraobserver reproducibility of Knodell HAI (Desmet modification, 25 cases), Ishak HAI (45 cases) and Scheuer system (25 cases) were studied with the use of kappa statistics. Total activity score reproducibility is fair in both modifications of HAI (kappa 0,23 and 0,25) while it is good in Scheuer system (kappa 0,65). For interface hepatitis moderate reproducibility (kappa 0,52) and moderate/good (kappa 0,95) were reached in Desmet HAI and Ishak HAI modifications respectively. It was very good (kappa 0,65) in Scheuer system. Reproducibility of lobular activity was fair in both modifications of HAI (kappa 0,56 and 0,46) and good in Scheuer system (kappa 0,66). Portal inflammation showed minimal reproducibility in Desmet HAI modification (kappa 0,17) and fair agreement in Ishak HAI modification. The construction of Scheuer system does not allow to evaluate portal inflammation grading. The reproducibility of staging score was good/very good in Desmet HAI modification (kappa 0,71) and very good in Ishak HAI modification (kappa 0,71) as well as in Scheuer system (kappa 0,87 and 0,95 respectively). Suggestions to improve definitions in Ishak system, to standardize microscopic field for local lobular activity grading and to standardize liver biopsy format are done. CD45RO method is a suitable method to evaluate focal lobular activity and piecemeal necrosis in difficult cases.Available from STL Prague, CZ / NTK - National Technical LibrarySIGLECZCzech Republi