NDLI: Histopathological algorithm and scoring system for evaluation of liver lesions in morbidly obese patients.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Bedossa, Pierre Poitou, Christine Veyrie, Nicolas Bouillot, Jean-Luc Basdevant, Arnaud Paradis, Valerie Tordjman, Joan Clement, Karine
Description	Country affiliation: France Author Affiliation: Bedossa P ( Assistance Publique-Hôpitaux de Paris, Beaujon Hospital, Pathology Department, Clichy, France. pierre.bedossa@bjn.aphp.fr)
Abstract	UNLABELLED: Nonalcoholic fatty liver disease (NAFLD) is highly prevalent and being 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 nonalcoholic steatohepatitis (NASH) was built based on semiquantitative evaluation of steatosis, hepatocellular ballooning, and lobular inflammation. For each case, the SAF score was created including the semiquantitative 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 because all patients with NASH had A ≥ 2, whereas no patients with A < 2 had NASH. This score was closely correlated with both alanine aminotransferase (ALT) and aspartate aminotransferase (AST) (P < 0.0001, analysis of variance [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 to report 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. CONCLUSION: We propose a simple but robust algorithm for categorizing liver lesions in NAFLD patients. Because liver lesions in obese patients may display a continuous spectrum of histologic lesions, we suggest describing liver lesions using the SAF score.
File Format	HTM / HTML
ISSN	02709139
Issue Number	5
Volume Number	56
e-ISSN	15273350
Journal	Hepatology
Language	English
Publisher	Wiley
Publisher Date	2012-11-01
Publisher Place	United States
Access Restriction	Subscribed
Subject Keyword	Discipline Hepatology Algorithms Fatty Liver Pathology Liver Cirrhosis Liver Obesity, Morbid Complications Adolescent Adult Aged Alanine Transaminase Blood Analysis Of Variance Aspartate Aminotransferases Biopsy Etiology Female Humans Male Middle Aged Non-alcoholic Fatty Liver Disease Surgery Observer Variation Reproducibility Of Results Young Adult Journal Article Research Support, Non-u.s. Gov't Validation Studies
Content Type	Text
Resource Type	Article
Subject	Hepatology

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