title: Nonalcoholic fatty liver disease: different classifications concordance and relationship between degrees of morphological features and spectrum of the disease.
abstract: The morphological features of nonalcoholic fatty liver disease (NAFLD) range from steatosis to nonalcoholic steatohepatitis (NASH) and cirrhosis. Liver biopsy remains the main tool for NASH diagnosis and many histological systems to diagnose and grade NAFLD were proposed. We evaluated the relationship among NAFLD activity score (NAS), histological diagnoses (non-NASH, possible NASH, and definite NASH), and histological algorithm proposed by Bedossa et al.; additionally the degrees of morphological features were semiquantified and correlated with non-NASH and NASH. Seventy-one liver biopsies were studied. The agreement among the three systems considering NASH and non-NASH was excellent (Κ = 0.96). Among the 22 biopsies with NAS 3-4, 72.7% showed to be NASH according to Bedossa's algorithm. The degree of steatosis, ballooning, lobular inflammation, and fibrosis stage were correlated with NASH (P < 0.001). Fibrosis stage 1 was also found in non-NASH. Over the spectrum of NAFLD, no association was observed between intensity of steatosis and fibrosis grade. The degrees of lobular inflammation showed association with fibrosis stage (P < 0.0001). In conclusion, there is agreement among different NAFLD classifications and NAS > 4 may be a better cutoff from which to consider NASH diagnosis; besides the highest degrees of steatosis, ballooning, inflammation, and fibrosis are associated with NASH.
authors.affiliation: Postgraduate Program, Department of Pathology, University Hospital, Faculty of Medicine, Federal University of Rio de Janeiro, Avenida Prof. Rodolpho Paulo Rocco 255, Cidade Universitária, 21941-913 Rio de Janeiro, RJ, Brazil.
authors.forename: Juliana Maya
authors.initials: JM
authors.lastname: Monteiro
authors.affiliation: Faculty of Medicine, Severino Sombra University, Avenida Expedicionário Oswaldo de Almeida Ramos 280, Centro, 27700-000 Vassouras, RJ, Brazil.
authors.forename: Geysa Maya
authors.initials: GM
authors.lastname: Monteiro
authors.affiliation: Department of Pathology, University Hospital, Faculty of Medicine, Federal University of Rio de Janeiro, Avenida Prof. Rodolpho Paulo Rocco 255, Cidade Universitária, 21941-913 Rio de Janeiro, RJ, Brazil.
authors.forename: Adriana
authors.initials: A
authors.lastname: Caroli-Bottino
authors.affiliation: Department of Pathology, University Hospital, Faculty of Medicine, Federal University of Rio de Janeiro, Avenida Prof. Rodolpho Paulo Rocco 255, Cidade Universitária, 21941-913 Rio de Janeiro, RJ, Brazil.
authors.forename: Vera Lucia
authors.initials: VL
authors.lastname: Pannain
mesh_terms: D000465:Algorithms; D006801:Humans; D065626:Non-alcoholic Fatty Liver Disease / Q000145:classification* / Q000175:diagnosis*