İnter Observer Agreement Of The Modified Ishak Histological Activity Index İn Chronic Viral Hepatitis Among Pathologists Trained İn Different Centers

Abstract
Aim: Liver biopsy is the gold standard for demonstrating hepatic damage in patients with chronic hepatitis. In this study, the reproducibility of the Modified Ishak Histological Activity Index (MHAI), used in the histopathological evaluation of chronic hepatitis, between observers trained in different centers was investigated.
Patients and Methods: A total of 64 liver needle biopsies were included in the study between 2020 and 2023. Sections of the cases stained with hematoxylin-eosin, silver and trichrome were re-evaluated under a light microscope by the investigator (İÇ) and re-scored according to MHAI. In statistical evaluation, Cohen's kappa statistics were applied using the SPSS 21.0 program.
Results: When all cases are taken into consideration in statistical evaluation, kappa value is; MAI was found to be 0.02 (slight) for degree and 0.38 (fair) for stage. When the researcher's compatibility with other pathologists was evaluated, the kappa values in the grading were quite low and found to be incompatible. Although there were higher values (0.12-0.49) in the stage than in the degree, the fit was poor and moderate. However, pathologists with a long-term history of collaboration showed higher levels of compliance, highlighting the importance of ongoing exchange of information.
Conclusion: This study highlights the need for a standardized approach to interpretation and application of MHAI scoring to increase reproducibility.
Keywords: Chronic hepatitis, interobserver agreement, Modified Ishak Activity Index