Abstract
This study aimed to test the diagnostic performance of a fully quantitative fibrosis assessment tool for liver fibrosis in patients with chronic hepatitis B (CHB), primary biliary cirrhosis (PBC) and non-alcoholic steatohepatitis (NASH). A total of 117 patients with liver fibrosis were included in this study, including 50 patients with CHB, 49 patients with PBC and 18 patients with NASH. All patients underwent liver biopsy (LB). Fibrosis stages were assessed by two experienced pathologists. Histopathological images of LB slices were processed by second harmonic generation (SHG)/two-photon excited fluorescence (TPEF) microscopy without staining, a system called qFibrosis (quantitative fibrosis) system. Altogether 101 quantitative features of the SHG/TPEF images were acquired. The parameters of aggregated collagen in portal, septal and fibrillar areas increased significantly with stages of liver fibrosis in PBC and CHB (P<0.05), but the same was not found for parameters of distributed collagen (P>0.05). There was a significant correlation between parameters of aggregated collagen in portal, septal and fibrillar areas and stages of liver fibrosis from CHB and PBC (P<0.05), but no correlation was found between the distributed collagen parameters and the stages of liver fibrosis from those patients (P>0.05). There was no significant correlation between NASH parameters and stages of fibrosis (P>0.05). For CHB and PBC patients, the highest correlation was between septal parameters and fibrosis stages, the second highest was between portal parameters and fibrosis stages and the lowest correlation was between fibrillar parameters and fibrosis stages. The correlation between the septal parameters of the PBC and stages is significantly higher than the parameters of the other two areas (P<0.05). The qFibrosis candidate parameters based on CHB were also applicable for quantitative analysis of liver fibrosis in PBC patients. Different parameters should be selected for liver fibrosis assessment in different stages of PBC compared with CHB.
Highlights
The severity of liver fibrosis is an important factor for long-term prognosis of liver disease
Spearman correlation analysis showed a significant correlation between parameters in portal, septal and fibrillar areas for both chronic hepatitis B (CHB) and primary biliary cirrhosis (PBC) samples (Po0.05), but no significant correlation was found between collagen parameters and stage of liver fibrosis for both CHB and PBC samples (P40.05)
There was no significant correlation between non-alcoholic steatohepatitis (NASH) parameters and fibrosis stages (P40.05) (Figure 2)
Summary
The severity of liver fibrosis is an important factor for long-term prognosis of liver disease. Studies show that liver fibrosis is a reversible process [1,2,3]. Accurate and quantitative assessment of liver fibrosis is very important in diagnosis, treatment and prognosis of liver disease. Liver biopsy is still the gold standard for quantitative assessment of liver fibrosis. From the initial subjective and descriptive diagnosis to the current semi-quantitative score system, the pathological assessment of liver fibrosis has improved greatly. Several semi-quantitative staging systems exist, including Knodell staging system, Ishak staging system, Metavir staging system, and others [4]. Semi-quantitative diagnosis is more convenient for clinical practitioners compared with the initial descriptive diagnosis, those methods are still not very reliable and repeatable because the results depend on the staining process
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