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Abstract Details
Nonalcoholic fatty liver disease: Reporting histologic findings in clinical practice
Hepatology. 2020 Oct 27. doi: 10.1002/hep.31599. Online ahead of print.
Elizabeth M Brunt1, David E Kleiner2, Danielle H Carpenter3, Mary Rinella4, Stephen A Harrison5, Rohit Loomba6, Zobair Younossi7, Brent A Neuschwander-Tetri8, Arun J Sanyal9, American Association for the Study of Liver Diseases NASH Task Force
Author information
1Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, 63110, United States.
2Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892.
3Department of Pathology, Saint Louis University, St. Louis, MO, 63104, United States.
4Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, United States.
5Hepatology, Radcliffe Department of Medicine, University of Oxford, UK.
6NAFLD Research Center, Division of Gastroenterology and Hepatology, University of California at San Diego, La Jolla, CA, 92093.
7Inova Medicine Services, Inova Health System, Falls Church, VA, 22042.
8Medicine, Division of Gastroenterology and Hepatology, Saint Louis University, St. Louis, MO, 63110, United States.
9Medicine, Physiology and Molecular Pathology, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, 23284.
Abstract
The role of liver biopsy in nonalcoholic steatohepatitis (NASH) has evolved along with the increased recognition of the significance of this disease, and the unmet medical need it presents. Drug development and clinical trials are rapidly growing, as are non-invasive tests for markers of steatosis, inflammation, injury and fibrosis. Liver biopsy evaluation remains necessary for both drug development and clinical trials as the most specific means of diagnosis and patient identification for appropriate intervention. This White Paper, sponsored by the American Association for the Study of Liver Disease NASH Task Force, is a focused review of liver biopsy evaluation in fatty liver disease in subjects with presumed NAFLD for practicing clinical hepatologists and pathologists. The goal is to provide succinct and specific means for reporting the histopathologic elements of NASH, distinguishing NASH from nonalcoholic fatty liver without steatohepatitis (NAFL), and from alcoholic steatohepatitis when possible. The discussion includes the special situations of NASH in advanced fibrosisor cirrhosis, and in the pediatric population. Finally, there is discussion of semiquantitative methods of evaluation of lesions of "disease activity" and fibrosis. Tables are present for scoring and a suggested model for final reporting. Figures presented highlight the histopathologic elements of NASH.