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Scoring system, algorithm accurately measured liver biopsies in NAFLD
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Use of a steatosis, activity and fibrosis scoring system and a fatty liver inhibition of progression algorithm accurately evaluated liver biopsies among patients with nonalcoholic fatty liver disease, according to study data.
Researchers included 40 liver biopsies in their study to determine whether using a steatosis, activity and fibrosis (SAF) scoring system and a fatty liver inhibition of progression (FLIP) algorithm would decrease interobserver variations between pathologists. Researchers conducted two sessions; in the first, pathologists categorized liver biopsies of patients with nonalcoholic fatty liver disease (NAFLD) according to their own experience. For the second session, the pathologists were masked and then reclassified the biopsies using FLIP and SAF. The mean biopsy length was 25 ± 3mm, with 18 biopsies classified as steatosis with nonalcoholic steatohepatitis (NASH) and 22 identified as steatosis without NASH.
Biopsy interpretation concordant with reference evaluation increased from 79% to 97% in group one and from 42% to 75% in group two using FLIP and SAF. Using the FLIP algorithm to classify biopsies in patients with metabolic syndrome was effective, since agreement with reference diagnosis increased from 31 to 39 biopsies in group one and from 17 to 30 in group two. The strength of concordance in classifying biopsies when applying the algorithm increased from moderate to substantial in group one and increased from fair to substantial in the second group.
SAF score produced substantial concordance for steatosis and activity and was nearly perfect for fibrosis in group one. Researchers said a similar trend occurred in group two.
“The use of the histological algorithm and the SAF score provides a reliable and reproducible diagnosis and grading/staging of NAFLD with reduced interobserver variability,” the researchers wrote. “These simple tools should complement and not replace the textual description of a liver biopsy report.”
Disclosure: The researchers report no relevant financial disclosures.