Histologic scoring systems for chronic liver disease
- Maria Isabel Fiel, MD, FAASLD
Maria Isabel Fiel, MD, FAASLD
- Professor of Pathology
- Icahn School of Medicine at Mount Sinai
- Section Editor
- Sanjiv Chopra, MD, MACP
Sanjiv Chopra, MD, MACP
- Editor-in-Chief — Gastroenterology/Hepatology
- Section Editor — General Hepatology; Gallbladder and Biliary Tract Disease
- Professor of Medicine
- Harvard Medical School
- Senior Consultant in Hepatology
- James Tullis Firm Chief
- Beth Israel Deaconess Medical Center
Histologic scoring systems for chronic liver disease are used to characterize and predict disease progression, to determine prognosis, to guide treatment strategies, and to provide standards in clinical trials.
This topic will review the major histologic scoring systems for chronic liver disease. The interpretation of liver biopsy specimens in general and methods to obtain liver biopsy specimens are discussed elsewhere. (See "Interpretation of liver biopsy specimens" and "Percutaneous, fine-needle aspiration, and laparoscopic liver biopsy" and "Transjugular liver biopsy".)
LIMITATIONS OF LIVER BIOPSY
There are several limitations of liver biopsy for assessing liver disease, including:
●Variable quality of liver biopsy specimens – Specimens shorter than 2 cm in length may be difficult to interpret. Larger caliber needles may yield better samples than fine needle biopsies [1,2]. As an example, small specimens may underestimate the degree of inflammatory activity and fibrosis in patients with viral hepatitis .
●Sampling variability – The assessment of liver histology is usually based on a percutaneous biopsy that samples a very small portion (1/50,000th) of the liver . Liver disease does not always affect the liver in a homogeneous pattern, leading to the possibility of sampling variability. The most common setting for sampling error is in a cirrhotic liver .
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- Brunt EM, Janney CG, Di Bisceglie AM, et al. Nonalcoholic steatohepatitis: a proposal for grading and staging the histological lesions. Am J Gastroenterol 1999; 94:2467.
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- Scheuer P. Primary biliary cirrhosis. Proc R Soc Med 1967; 60:1257.
- Ludwig J, Dickson ER, McDonald GS. Staging of chronic nonsuppurative destructive cholangitis (syndrome of primary biliary cirrhosis). Virchows Arch A Pathol Anat Histol 1978; 379:103.
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- LIMITATIONS OF LIVER BIOPSY
- CHRONIC HEPATITIS
- Knodell score/histology activity index
- METAVIR score
- Ishak score (modified Knodell score)
- Scheuer system
- Batts-Ludwig system (modified Scheuer system)
- Laennec staging system
- DISEASE-SPECIFIC SCORING SYSTEMS
- Nonalcoholic fatty liver disease
- Alcoholic hepatitis
- Primary biliary cirrhosis
- Primary sclerosing cholangitis
- Autoimmune hepatitis