Abstract
BackgroundLiver biopsy has been the standard procedure for diagnosing and evaluating the severity of non‐alcoholic fatty liver disease (NAFLD) and non‐alcoholic steatohepatitis (NASH); however, interobserver discordance remains a critical issue in its pathological diagnosis.Methods and ResultsWe examined the concordance rates of pathological scoring and diagnosis between pathologists at individual institutions (local diagnosis) and two central pathologists specialized in liver pathology (central diagnosis). A total of 150 patients with NAFLD underwent prospective liver biopsies. NAFLD activity score (NAS) and fibrosis stage were evaluated, and NASH was determined according to Matteoni's classification. NAS, scores for all NAS components, and fibrosis stage were diagnosed at a lower degree by central compared with local diagnosis. NASH was diagnosed in 34% of the patients according to central pathologists compared with 54% according to local pathologists (P < 0.001). The concordance rates for NAS, steatosis, inflammation, ballooning, fibrosis, and NASH diagnosis were 26.7, 62.7, 51.3, 48.7, 43.3, and 50.7%, respectively. The correlation coefficient between local and central diagnoses was the lowest for the scoring of ballooning (ρ = 0.218).ConclusionConcordance rates among pathologists for the evaluation of NAFLD are currently poor, and simple and reliable diagnostic and evaluation criteria are urgently needed to improve the clinical management of NAFLD patients.
Highlights
Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide and affects about 25% of the world population.[1]
The concordance rates for the diagnosis of steatosis, lobular inflammation, and ballooning according to NAFLD activity score (NAS) were 62.7, 51.3, Table 1 Comparison of pathological scoring and staging of non-alcoholic fatty liver disease (NAFLD) between local and central pathologists
The current study demonstrated a serious discordance between pathologists in the pathological diagnosis of NAFLD
Summary
Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide and affects about 25% of the world population.[1]. NAFLD is classified as non-alcoholic fatty liver (NAFL) or non-alcoholic steatohepatitis (NASH), of which NASH is pathologically characterized by lobular inflammation and the presence of hepatocellular ballooning with or without fibrosis.[2,3]. Recent studies demonstrated that fibrosis, rather than other histological features, was indicative of all-cause and disease-specific mortality in patients with NAFLD.[6–9]. These studies concluded that the severity of hepatic fibrosis was the most important pathological finding predicting the clinical outcome of NAFLD, rather than a diagnosis of NASH, which requires hepatocyte ballooning according to Matteoni’s classification.[2]. Liver biopsy has been the standard procedure for diagnosing and evaluating the severity of non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH); interobserver discordance remains a critical issue in its pathological diagnosis. Conclusion: Concordance rates among pathologists for the evaluation of NAFLD are currently poor, and simple and reliable diagnostic and evaluation criteria are urgently needed to improve the clinical management of NAFLD patients
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