title: A comparative evaluation of scoring systems for assessing necro-inflammatory activity and fibrosis in liver biopsies of patients with chronic viral hepatitis.
abstract: BACKGROUND
  To compare the five scoring systems in assessing grading and staging of liver biopsies from patients with chronic viral hepatitis and their problems and pitfalls.
  
  
  METHODS
  Liver biopsies from 25 patients with chronic viral hepatitis were studied. Sections were stained with Haematoxylin and Eosin, Reticulin and Masson's Trichrome stains. Van Gieson, Perl's and Shikata's Orcein stains were used as and when required. Coded histological sections were scored independently by three histopathologists using the Knodell Histology Activity Index (HAI), the Scheuer scoring system, Ishak's system, Metavir system and Ishak modified HAI.
  
  
  RESULTS
  There were 15 males and 10 females. Their mean age was 51.24 years. On histological examination, hepatocytes showed degenerative changes with varying grades of necrosis (spotty and confluent). Widening of portal tracts with varying severity of mononuclear inflammatory infiltrate and interface hepatitis was observed. Fibrosis appeared as periportal, portal-portal and portal-central septa. A significant agreement was found by kappa statistics for both grading (p< 0.001) as well as staging (p < 0.001) among all the five scoring systems. Lobular activity was the only parameter that showed some discrepancy. No significant intra observer difference was observed.
  
  
  CONCLUSIONS
  It is concluded that all the scoring systems are equally good for grading and staging in the hands of an experienced hepatopathologists.
authors.affiliation: Associate Professor, Department of Pathology, Sri Guru Ram Das Institute of Medical Sciences and Research , Vallah, Amritsar, (Punjab), India .
authors.forename: Rahul
authors.initials: R
authors.lastname: Mannan
authors.affiliation: Professor and Head, Department of Pathology, Moti Lal Nehru Medical College , Allahabad (Uttar Pradesh), India .
authors.forename: Vatsala
authors.initials: V
authors.lastname: Misra
authors.affiliation: Professor, Department of Gastroentrology, Moti Lal Nehru Medical College , Allahabad (Uttar Pradesh), India .
authors.forename: S P
authors.initials: SP
authors.lastname: Misra
authors.affiliation: Professor, Department of Pathology, Moti Lal Nehru Medical College , Allahabad (Uttar Pradesh), India .
authors.forename: Pramela A
authors.initials: PA
authors.lastname: Singh
authors.affiliation: Professor, Department of Gastroentrology, Moti Lal Nehru Medical College , Allahabad (Uttar Pradesh), India .
authors.forename: Manisha
authors.initials: M
authors.lastname: Dwivedi
keywords: Fibrosis; Liver biopsy; Necro-inflammatory activity; Score