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A scoring system for the diagnosis of non-alcoholic steatohepatitis from liver biopsy

Journal of Pathology and Translational Medicine 2020년 54권 3호 p.228 ~ 236
이경분, 정은선, 유은실, 강윤경, 조미원, 김준미, 문우성, 정진숙, 박철근, 박재복, 강대영, 손진희, 진소영,
소속 상세정보
이경분 ( Lee Kyoung-Bun ) - Seoul National University College of Medicine Department of Pathology
정은선 ( Jung Eun-Sun ) - Catholic University College of Medicine Seoul St. Mary’s Hospital Department of Pathology
유은실 ( Yu Eun-Sil ) - University of Ulsan College of Medicine Asan Medical Center Department of Pathology
강윤경 ( Kang Yun-Kyung ) - Inje University Seoul Paik Hospital Department of Pathology
조미원 ( Cho Mee-Yon ) - Yonsei University Wonju College of Medicine Department of Pathology
김준미 ( Kim Joon-Mee ) - Inha University Hospital Department of Pathology
문우성 ( Moon Woo-Sung ) - Chonbuk National University Medical School Department of Pathology
정진숙 ( Jeong Jin-Sook ) - Dong-A University College of Medicine Department of Pathology
박철근 ( Park Cheol-Keun ) - Seegene Medical Foundation Anatomic Pathology Reference Lab
박재복 ( Park Jae-Bok ) - Catholic University of Daegu School of Medicine Department of Pathology
강대영 ( Kang Dae-Young ) - Chungnam National University Hospital Department of Pathology
손진희 ( Sohn Jin-Hee ) - Sungkyunkwan University School of Medicine Kangbuk Samsung Hospital Department of Pathology
진소영 ( Jin So-Young ) - SoonChunHyang University Seoul Hospital Department of Pathology

Abstract


Background: Liver biopsy is the essential method to diagnose non-alcoholic steatohepatitis (NASH), but histological features of NASH are too subjective to achieve reproducible diagnoses in early stages of disease. We aimed to identify the key histological features of NASH and devise a scoring model for diagnosis.

Methods: Thirteen pathologists blindly assessed 12 histological factors and final histological diagnoses (‘not-NASH,’ ‘borderline,’ and ‘NASH’) of 31 liver biopsies that were diagnosed as non-alcoholic fatty liver disease (NAFLD) or NASH before and after consensus. The main histological parameters to diagnose NASH were selected based on histological diagnoses and the diagnostic accuracy and agreement of 12 scoring models were compared for final diagnosis and the NAFLD Activity Score (NAS) system.

Results: Inter-observer agreement of final diagnosis was fair (κ = 0.25) before consensus and slightly improved after consensus (κ = 0.33). Steatosis at more than 5% was the essential parameter for diagnosis. Major diagnostic factors for diagnosis were fibrosis except 1C grade and presence of ballooned cells. Minor diagnostic factors were lobular inflammation (≥ 2 foci/ × 200 field), microgranuloma, and glycogenated nuclei. All 12 models showed higher inter-observer agreement rates than NAS and post-consensus diagnosis (κ = 0.52?0.69 vs. 0.33). Considering the reproducibility of factors and practicability of the model, summation of the scores of major (× 2) and minor factors may be used for the practical diagnosis of NASH.

Conclusions: A scoring system for the diagnosis of NAFLD would be helpful as guidelines for pathologists and clinicians by improving the reproducibility of histological diagnosis of NAFLD.

키워드

Non-alcoholic fatty liver disease; Non-alcoholic steatohepatitis; Biopsy; Consensus

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