Histopathological algorithm and scoring system for evaluation of liver lesions in morbidly obese patients.
Summary of "Histopathological algorithm and scoring system for evaluation of liver lesions in morbidly obese patients."
NAFLD is highly prevalent and overweight is a significant risk factor. The aim was to build an algorithm along with a scoring system for histopathologic classification of liver lesions that covers the entire spectrum of lesions in morbidly obese patients. A cohort of 679 obese patients undergoing liver biopsy at the time of bariatric surgery was studied. An algorithm for segregating lesions into normal liver, NAFLD or NASH was built based on semi-quantitative evaluation of steatosis, hepatocellular ballooning and lobular inflammation. For each case, the SAF score was created including the semi-quantitative scoring of steatosis (S), activity (A) and fibrosis (F). Based on the algorithm, 230 obese patients (34%) were categorized as NASH, 291 (43%) as NAFLD without NASH and 158 (23%) as not NAFLD. The activity score (ballooning + lobular inflammation) enabled discriminating NASH since all patients with NASH had A≤2 while no patients with A<2 had NASH. This score was closely correlated with both ALT and AST (p<0.0001, ANOVA). Comparison of transaminase levels between patients with normal liver and pure steatosis did not reveal significant differences thus lending support to the proposal not to include steatosis in the activity score but reporting it separately in the SAF score. In the validation series, the interobserver agreement for the diagnosis of NASH was excellent (κ =0.80) between liver pathologists. There was no discrepancy between the initial diagnosis and the diagnosis proposed using the algorithm. In conclusion, we propose a simple but robust algorithm for categorizing liver lesions in NAFLD patients. Since liver lesions in obese patients may display a continuous spectrum of histologic lesions, we suggest describing liver lesions using the SAF score. (HEPATOLOGY 2012.).
Assistance Publique-Hôpitaux de Paris, Beaujon Hospital, Pathology Department, Clichy, F-92110 France; Centre de Recherche Bichat-Beaujon, INSERM U773, University Paris-Diderot, Paris, France. email@example.com.
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Name: Hepatology (Baltimore, Md.)
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