Anatomic Pathology: Liver Pathology

• The Scheuer, modified Ishak, Batts-Ludwig, and Knodell scoring systems are several semiquantitative histologic systems for assessing the grade of necroinflammation and stage of fibrosis or cirrhosis in chronic hepatitis of varied etiologies.

• The METAVIR scoring system is the French scoring system for chronic hepatitis (an algorithmic method) and assesses both interface hepatitis and lobular necrosis to determine overall histologic activity and scores fibrosis or cirrhosis using categories of 0 to 4.

• Neonatal Abstinence Syndrome (NAS) is a score used to assess the likelihood that nonalcoholic steatohepatitis is present in a biopsy specimen with large droplet (macrovesicular) steatosis. The NAS is a total number composed of steatosis (0 to 3), lobular inflammation (0 to 3), and hepatocyte ballooning (0 to 2), with a range of 0 to 8.

• Pathologists whose practices include liver biopsy interpretation in cases of chronic hepatitis (particularly in the grading and staging of chronic hepatitis B and C and autoimmune chronic hepatitis) should select a scoring system from the several choices outlined in the Choices. The optimal scoring system is one that is readily accomplished during biopsy reporting, has strong interobserver reproducibility, and communicates the appropriate information to the patient and the clinical team. The clinical team in particular should fully understand the definitions of each score used in the given scoring system selected.

• Semiquantitative grading and staging for chronic hepatitis results in categorical data, rather than absolute numerical data (e.g., serum aspartate aminotransferase = 152 U/L). When applying statistical methods to such data, appropriate statistical tools for categorical data should be used.

Batts KP, Ludwig J: Chronic hepatitis. An update on terminology and reporting. Am J Surg Pathol 1995;19(12):1409-1417.

Ishak K, Baptista A, Bianchi L, et al: Histological grading and staging of chronic hepatitis. J Hepatol 1995;22(6):696-699.

Kleiner DE, Brunt EM, Van Natta M, et al: Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology 2005;41(6):1313-1321.

Scheuer PJ: Classification of chronic viral hepatitis: a need for reassessment. J Hepatol 1991;13(3):372-374.

* = Required 
* Note Title
* Note