Dixon et al used a modification of the criteria proposed by Lee for the histologic scoring of liver biopsies from patients with nonalcoholic steatohepatitis (NASH). This can be used during the initial evaluation of the patient; it can also be used later to monitor disease progression and the impact of therapeutic interventions.
Criteria for histologic diagnosis on nonalcoholic steatohepatitis (NASH):
(1) steatosis
(2) 2 or 3 of the following, centered about zone 3 of the hepatic lobule:
(2a) necro-inflammatory foci with mononuclear cells and/or neutrophils
(2b) ballooning degeneration of hepatocytes with or without Mallory bodies
(2c) pericellular fibrosis
Graded histologic parameters:
(1) steatosis
(2) inflammation
(3) fibrosis
|
Parameter |
Finding |
Score |
|
steatosis involving lobular parenchyma |
none |
0 |
|
|
< 5% of lobular parenchyma involved |
1 |
|
|
5 – 25% |
2 |
|
|
26 – 75% |
3 |
|
|
> 75% |
4 |
|
inflammation |
no hepatocyte injury or inflammation |
0 |
|
|
sparse inflammation in zone 3 |
1 |
|
|
mild focal inflammation in zone 3 with hepatocyte injury |
2 |
|
|
noticeable inflammation and hepatocyte injury in zone 3 |
3 |
|
|
severe inflammation and hepatocyte injury in zone 3 |
4 |
|
fibrosis |
no increase (normal connective tissue) |
0 |
|
|
focal pericellular fibrosis in zone 3 |
1 |
|
|
perivenular and pericellular fibrosis confined to zones 2 and 3 with or without portal/periportal fibrosis |
2 |
|
|
bridging or extensive fibrosis with architectural distortion |
3 |
|
|
cirrhosis |
4 |
where:
• Portal fibrosis in the absence of zone 3 pericellular fibrosis is disregarded when scoring the fibrosis.
• The scoring of the fibrosis is based on that of Brunt et al (above).
Purpose: To evaluate a liver biopsy from a patient with nonalcoholic steatohepatitis (NASH) using a modification of the criteria proposed by Lee.
Specialty: Gastroenterology, Nutrition
Objective: risk factors, severity, prognosis, stage, disease progression
ICD-10: K75.8,
