title: Histological Evaluation of Non-alcoholic Fatty Liver Disease and Its Correlation with Different Noninvasive Scoring Systems with Special Reference to Fibrosis: A Single Center Experience.
abstract: BACKGROUND
  Although liver biopsy remains the gold standard for the diagnosis of non-alcoholic fatty liver disease [NAFLD], many non-invasive markers of liver fibrosis have recently been proposed and assessed as surrogates of liver biopsy.
  
  
  OBJECTIVE
  To evaluate the degree of liver fibrosis by different non-invasive fibrosis scoring systems and to compare each non-invasive fibrosis scoring system with histological fibrosis stage.
  
  
  METHODS
  The study population consists of consecutive patients with biopsy proven NAFLD. Complete medical history was taken and physical examination was done in all patients along with appropriate biochemical evaluations. NAFLD fibrosis score, BARD score, BAAT score and APRI score were calculated and each score was compared with histological fibrosis staging.
  
  
  RESULTS
  The study population consisted of 60 patients having mean age 39.73 years (SD 9.62, range 17-63 years) including 51 (85%) males and 9 (15%) females. On histology fibrosis was present in 68.3% (41/60) patients. Out of 60 patients 41 had fibrosis and among them 17, 22, 2 patients had grade 1, 2, 3 fibrosis respectively and no one had grade 4 fibrosis. 61.67% (37/60) had definite NASH. Comparing the fibrosis of histology with the noninvasive scoring systems, the sensitivity and specificity of NAFLD fibrosis score were 5.56% and 100% respectively. BARD score had 45.83% sensitivity and 80.55% specificity. The sensitivities of BAAT score and APRI score were 0% and 29.16% respectively and the specificities were 100% and 97.22% respectively.
  
  
  CONCLUSIONS
  The noninvasive scoring systems like NFS, BARD, BAAT, and APRI are not sensitive enough to detect fibrosis but highly specific to include fibrosis if scores are more than cut-off values in our cohort, however they cannot replace liver biopsy. Newer more efficient non-invasive scoring systems have to be devised for the Indian NAFLD population.
authors.affiliation: Department of Pathology, IMS & SUM Hospital, Bhubaneswar 751003, Odisha, India.
authors.forename: Mitali M
authors.initials: MM
authors.lastname: Rath
authors.affiliation: Department of Gastroenterology, AIIMS, Bhubaneswar 751019, Odisha, India.
authors.forename: Manas K
authors.initials: MK
authors.lastname: Panigrahi
authors.affiliation: Department of Pathology, S.C.B. Medical College, Cuttack 753007, Odisha, India.
authors.forename: Kaumudee
authors.initials: K
authors.lastname: Pattnaik
authors.affiliation: Department of Pathology, S.C.B. Medical College, Cuttack 753007, Odisha, India.
authors.forename: Pallavi
authors.initials: P
authors.lastname: Bhuyan
authors.affiliation: Department of Gastroenterology, S.C.B. Medical College, Cuttack 753007, Odisha, India.
authors.forename: Sanjib K
authors.initials: SK
authors.lastname: Kar
authors.affiliation: Department of Gastroenterology, S.C.B. Medical College, Cuttack 753007, Odisha, India.
authors.forename: Bijay
authors.initials: B
authors.lastname: Misra
authors.affiliation: Department of Gastroenterology, S.C.B. Medical College, Cuttack 753007, Odisha, India.
authors.forename: Debasis
authors.initials: D
authors.lastname: Misra
authors.affiliation: Department of Radiology, Beam Diagnostics Centre, Bajrakabati Road, Cuttack 753001, Odisha, India.
authors.forename: Chudamani
authors.initials: C
authors.lastname: Meher
authors.affiliation: Department of Radiology, Beam Diagnostics Centre, Bajrakabati Road, Cuttack 753001, Odisha, India.
authors.forename: Omprakash
authors.initials: O
authors.lastname: Agrawal
authors.affiliation: Department of Pathology, S.C.B. Medical College, Cuttack 753007, Odisha, India.
authors.forename: Jayshree
authors.initials: J
authors.lastname: Rath
authors.affiliation: Department of Gastroenterology, S.C.B. Medical College, Cuttack 753007, Odisha, India.
authors.forename: Shivaram P
authors.initials: SP
authors.lastname: Singh
keywords: ALT, alanine aminotransferase; APRI; APRI, aspartate aminotransferase (AST)-to-platelet ratio index; AST, aspartate aminotransferase; BAAT; BARD; BMI, body mass index; DM, diabetes mellitus; NAFLD, non-alcoholic fatty liver disease; NAS, NAFLD fibrosis score; NASH, non-alcoholic steatohepatitis; NPV, negative predictive value; PPV, positive predictive value; ROC, receiver operating characteristic; SGOT, serum glutamic oxaloacetic transaminases; SGPT, serum glutamic pyruvate transaminases; TG, triglyceride; TPC, total platelet count; fibrosis; nonalcoholic fatty liver disease (NAFLD)