Michel Henry Mendler1, Gary Kanel, Sugantha Govindarajan. 1. Division of Gastrointestinal and Liver Diseases, Rancho Los Amigos Liver Unit, University of Southern California, 2011 Zonal Avenue, Los Angeles, CA 90033, USA. mendler@hsc.usc.edu
Abstract
AIM/ BACKGROUND: The spectrum of histopathological features in non-alcoholic fatty liver disease (NAFLD) has been well described. At least two scoring systems have been established. We propose here a system in which numerical scores are obtained using the different features. METHODS: Twenty-five cases of well-defined NAFLD were identified. Two pathologists blinded to identifiers and clinical data independently scored the liver biopsies twice for portal fibrosis (PF: 0-6), lobular inflammation and necrosis (LIN: 0-3), Mallory bodies (MB: 0-3), hepatocyte ballooning (HB: 0-3), perisinusoidal fibrosis (PSF: 0-3) and fatty change (FC: 1-4). The kappa statistic tested observer concordance. Non-parametric measures of correlation and hierarchical cluster analysis were used to elaborate a grading system. RESULTS: A broad spectrum of NAFLD was observed. Intra- and interobserver concordance was satisfactory. An activity score was created (AS: 0-12) as the sum of LIN, MB, HB and PSF, but not FC. A system for severity of NAFLD was developed: Grade 1 (PF: 0-2 and AS: 0-4), Grade 2 (PF: 3 or AS: 5-7) and Grade 3 (PF: 4-6 or AS: 8-12). Diabetes, elevated alkaline phosphatase and decreased platelets were associated with advanced grade. CONCLUSIONS: This simple, reproducible NAFLD score produces a three-tier severity grade. This numerical system may prove useful in assessing disease severity and interval changes. Copyright Blackwell Munksgaard 2005
AIM/ BACKGROUND: The spectrum of histopathological features in non-alcoholic fatty liver disease (NAFLD) has been well described. At least two scoring systems have been established. We propose here a system in which numerical scores are obtained using the different features. METHODS: Twenty-five cases of well-defined NAFLD were identified. Two pathologists blinded to identifiers and clinical data independently scored the liver biopsies twice for portal fibrosis (PF: 0-6), lobular inflammation and necrosis (LIN: 0-3), Mallory bodies (MB: 0-3), hepatocyte ballooning (HB: 0-3), perisinusoidal fibrosis (PSF: 0-3) and fatty change (FC: 1-4). The kappa statistic tested observer concordance. Non-parametric measures of correlation and hierarchical cluster analysis were used to elaborate a grading system. RESULTS: A broad spectrum of NAFLD was observed. Intra- and interobserver concordance was satisfactory. An activity score was created (AS: 0-12) as the sum of LIN, MB, HB and PSF, but not FC. A system for severity of NAFLD was developed: Grade 1 (PF: 0-2 and AS: 0-4), Grade 2 (PF: 3 or AS: 5-7) and Grade 3 (PF: 4-6 or AS: 8-12). Diabetes, elevated alkaline phosphatase and decreased platelets were associated with advanced grade. CONCLUSIONS: This simple, reproducible NAFLD score produces a three-tier severity grade. This numerical system may prove useful in assessing disease severity and interval changes. Copyright Blackwell Munksgaard 2005
Authors: Charles H C Pilgrim; Laveniya Satgunaseelan; Alan Pham; William Murray; Emma Link; Marty Smith; Val Usatoff; Peter M Evans; Simon Banting; Benjamin N Thomson; Wayne A Phillips; Michael Michael Journal: HPB (Oxford) Date: 2012-03-26 Impact factor: 3.647
Authors: Charles H C Pilgrim; Kate Brettingham-Moore; Alan Pham; William Murray; Emma Link; Marty Smith; Val Usatoff; Peter M Evans; Simon Banting; Benjamin N Thomson; Michael Michael; Wayne A Phillips Journal: HPB (Oxford) Date: 2011-08-02 Impact factor: 3.647
Authors: Michael Nathan VanSaun; In Kyu Lee; Mary Kay Washington; Lynn Matrisian; David Lee Gorden Journal: Am J Pathol Date: 2009-06-18 Impact factor: 4.307