Digital quantification is more precise than traditional semiquantitation of hepatic steatosis: correlation with fibrosis in 220 treatment-naïve patients with chronic hepatitis C.
BACKGROUND
Steatosis, as associated with chronic hepatitis C (CHC) and non-alcoholic fatty liver disease (NAFLD), has been considered a risk factor for development of fibrosis.


OBJECTIVE
Our aims were to determine if correlations existed between the degree of steatosis and fibrosis in treatment-naïve CHC patients, and to compare the accuracy of digital image analysis with semiquantification (manual assessment) to quantify hepatic steatosis.


METHODS
We studied 220 treatment-naïve, liver biopsy-proven CHC patients, including a serial biopsy sub-cohort of 37 patients with a mean interval of 3.82 years. Steatosis and fibrosis % were evaluated using digital quantification of steatosis (DQS) and fibrosis contrasted with manual assessment.


RESULTS
Most patients had <6% steatosis measured manually and digitally. Overall, manual assessment of steatosis was 3.78 times greater than DQS. Increasing steatosis % was associated with advancing fibrosis stage, both manually and digitally. Intraobserver reliability for DQS showed higher intraclass correlation reproducibility (r = 0.98, P < 0.001) than the manual method (r = 0.81, P < 0.01). Interobserver concordance for DQS had an average measure intraclass correlation of r = 0.99. Cirrhotics were more likely than non-cirrhotics to have grade 2 steatosis.


CONCLUSIONS
Increased steatosis was associated with increased fibrosis. DQS was consistently more precise and reproducible than manual assessment of steatosis in grades 1 (1 to <6%) and 2 (6 to <34%), and may prove to be especially preferable in clinical trials of pharmacotherapeutic agents.
Rawlins
Sekou R
SR
Department of Medicine, Division of Gastroenterology, State University of New York, Upstate Medical University, Syracuse, NY 13210, USA.
El-Zammar
Ola
O
Zinkievich
J Michael
JM
Newman
Nancy
N
Levine
Robert A
RA
D000368:Aged; D000886:Anthropometry; D001707:Biopsy, Needle; D015331:Cohort Studies; D016001:Confidence Intervals; D003952:Diagnostic Imaging / Q000379:methods*; D005234:Fatty Liver / Q000175:diagnosis / Q000473:pathology*; D005260:Female; D019698:Hepatitis C, Chronic / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007150:Immunohistochemistry; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
Hepatology. 2002 Sep;36(3):729-36
12198667
Psychol Res. 1988;50(3):148-54
3217472
J Hepatol. 2008 May;48(5):736-42
18329125
Clin Gastroenterol Hepatol. 2007 Feb;5(2):245-54
17296533
Hepatology. 2005 Jun;41(6):1313-21
15915461
Hepatology. 1999 Apr;29(4):1215-9
10094967
Gastroenterology. 2006 May;130(6):1636-42
16697727
Hepatology. 2003 Jul;38(1):75-85
12829989
Hepatology. 2001 Jun;33(6):1358-64
11391523
Clin Gastroenterol Hepatol. 2006 Oct;4(10):1271-7
16901770
Hepatology. 2002 Nov;36(5):1266-72
12395339
J Hepatol. 2004 Mar;40(3):484-90
15123364
J Clin Gastroenterol. 2007 Feb;41(2):206-10
17245221
Gastroenterology. 2005 Jul;129(1):113-21
16012941
J Hepatol. 1998 Mar;28(3):439-46
9551682
J Hepatol. 2004 Jan;40(1):147-54
14672626
Gastroenterology. 2009 Aug;137(2):549-57
19445938
Hepatology. 2009 Jun;49(6):1828-37
19291787
Hepatology. 1997 Apr;25(4):1028-31
9096615
N Engl J Med. 2006 Nov 30;355(22):2297-307
17135584
Am J Gastroenterol. 2008 Apr;103(4):928-36
18371145
Gastroenterology. 2002 May;122(6):1649-57
12016429
Anal Quant Cytol Histol. 2007 Aug;29(4):244-50
17879633
J Hepatol. 1995 Jun;22(6):696-9
7560864
Hepatology. 2004 Dec;40(6):1387-95
15565570
Liver Int. 2009 Apr;29(4):530-5
19018987
Liver Int. 2005 Dec;25(6):1142-9
16343064
Hepatology. 2006 Apr;43(4):780-7
16557550
Mod Pathol. 2005 Jul;18(7):912-6
15920560
Hepatology. 2006 Oct;44(4):865-73
17006923
Gastroenterology. 2005 Jun;128(7):1898-906
15940625
Am J Clin Pathol. 2000 Nov;114(5):712-8
11068544
Hepatology. 2007 Apr;45(4):886-94
17393526
Cancer. 2003 Jun 15;97(12):3036-43
12784339
Hepatology. 2005 Jan;41(1):82-7
15690484
J Hepatol. 2000 Mar;32(3):453-64
10735616
Gut. 2002 Jul;51(1):89-94
12077098
J Clin Pathol. 2001 Jun;54(6):461-5
11376020
Semin Liver Dis. 2001;21(1):3-16
11296695
Mod Pathol. 1998 Jun;11(6):560-5
9647594