title: Assessment of liver fibrosis in primary biliary cholangitis: Comparison between indirect serum markers and fibrosis morphometry.
abstract: BACKGROUND
  The accuracy of non-invasive methods for the quantification of liver fibrosis in primary biliary cholangitis (PBC) is still debated.
  
  
  OBJECTIVE
  To determine the histo-morphometric measurement of fibrotic tissue and to explore the possible association between indirect markers (APRI, FORNS, FIB-4, and Lok) and morphometry.
  
  
  METHODS
  Retrospective analysis of medical data from patients with PBC, on whom needle liver biopsy was performed as part of the diagnostic assessment. One section of each biopsy stained with Sirius red was used for calculating the percentage of collagen. Quantitative measure of fibrotic tissue (fibrosis morphometry) was calculated as a percentage of collagen content by digital image analysis. Morphometry results were divided into four groups reflecting Ludwig's staging and compared with values for indirect serum markers.
  
  
  RESULTS
  50 PBC patients were enrolled (86% females, mean age 57 ± 12.30 years), 19 were Ludwig's stage I (38%), 14 stage II (28%), 12 stage III (24%), and five stage IV (10%). Morphometry results were significantly different among Ludwig stages (p<0.05). No significant differences were found for indirect serum markers. A significant correlation was found between morphometry results and indirect serum markers tested (p<0.05).
  
  
  CONCLUSIONS
  In our cohort, the histo-morphometric values of fibrotic tissue increased progressively with Ludwig's stages of PBC, while non-invasive markers did not.
authors.affiliation: Department of Experimental and Clinical Medicine, University of Florence, Italy. Electronic address: cristina.stasi@gmail.com.
authors.forename: Cristina
authors.initials: C
authors.lastname: Stasi
authors.affiliation: Department of Clinical and Experimental Biomedical Sciences, University of Florence, Italy.
authors.forename: Luisa
authors.initials: L
authors.lastname: Leoncini
authors.affiliation: Department of Clinical and Experimental Biomedical Sciences, University of Florence, Italy.
authors.forename: Maria Rosa
authors.initials: MR
authors.lastname: Biagini
authors.affiliation: Department of Experimental and Clinical Medicine, University of Florence, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Arena
authors.affiliation: Department of Experimental and Clinical Medicine, University of Florence, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Madiai
authors.affiliation: Department of Experimental and Clinical Medicine, University of Florence, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Laffi
authors.affiliation: Department of Experimental and Clinical Medicine, University of Florence, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Marra
authors.affiliation: Department of Clinical and Experimental Biomedical Sciences, University of Florence, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Milani
mesh_terms: D000368:Aged; D000410:Alanine Transaminase / Q000097:blood*; D000469:Alkaline Phosphatase / Q000097:blood*; D001219:Aspartate Aminotransferases / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D001707:Biopsy, Needle; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008099:Liver / Q000473:pathology*; D008105:Liver Cirrhosis, Biliary / Q000097:blood / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D005723:gamma-Glutamyltransferase / Q000097:blood*
chemical_list: D015415:Biomarkers; D005723:gamma-Glutamyltransferase; C554782:gamma-glutamyltransferase, human; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D000469:Alkaline Phosphatase
keywords: Fibrosis; Indirect serum markers; Ludwig's stages; Morphometry; Primary biliary cirrhosis