Formulation and application of a numerical scoring system... : Hepatology (original) (raw)

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Formulation and application of a numerical scoring system for assessing histological activity in asymptomatic chronic active hepatitis†

Knodell, Robert G. M.D.*, 1, 2, 3, 4, 5, 6; Ishak, Kamal G.1, 2, 3, 4, 5, 6; Black, William C.1, 2, 3, 4, 5, 6; Chen, Thomas S.1, 2, 3, 4, 5, 6; Craig, Robert1, 2, 3, 4, 5, 6; Kaplowitz, Neil1, 2, 3, 4, 5, 6; Kiernan, Thomas W.1, 2, 3, 4, 5, 6; Wollman, Jerome1, 2, 3, 4, 5, 6

1Gastroenterology Section, Veterans Administration Medical Center, Minneapolis, Minnesota 55417

2Department of Hepatic Pathology, Armed Forces Institute of Pathology, Washington, D.C. 20306

3University of New Mexico School of Medicine, Albuquerque, New Mexico 87140

4Veterans Administration Medical Center, East Orange, New Jersey 07019

5Lakeside Veterans Administration Medical Center, Chicago, Illinois 60612

6Wadsworth Veterans Administration Medical Center, Los Angeles, California 90073

*Address reprint requests to: Gastroenterology Section (111D), VA Medical Center, 54th Street and 48th Avenue South, Minneapolis, Minnesota 55417.

Received January 23, 1981; Accepted June 17, 1981; previously published online March 01, 2006

†Results of this study were presented at the annual meeting of the American Society for the Study of Liver Disease, Chicago, Illinois, November 1980, and have appeared in abstract form (1).

Abstract

A Histology Activity Index has been developed which generates a numerical score for liver biopsy specimens obtained from patients with asymptomatic chronic active hepatitis. Biopsies are graded in four categories: periportal necrosis, intralobular necrosis, portal inflammation, and fibrosis. Under code, three pathologists and three hepatologists evaluated 14 liver biopsy specimens obtained from five patients with asymptomatic chronic active hepatitis. Good correlation was seen between severity of liver biopsy lesions as judged by conventional histological descriptions and Histology Activity Index scores. Significant differences in Histology Activity Index score occurred in only 2 of 28 duplicate scorings of biopsy specimens by two observers. This system provides definitive endpoints for statistical analysis of serial changes in liver histology and offers an alternative to the use of conventional pathological descriptions in following the natural history and treatment responses of asymptomatic chronic active hepatitis.