%0 Journal Article
%T Nonalcoholic Fatty Liver Disease: Different Classifications Concordance and Relationship between Degrees of Morphological Features and Spectrum of the Disease
%A Juliana Maya Monteiro
%A Geysa Maya Monteiro
%A Adriana Caroli-Bottino
%A Vera Lucia Pannain
%J Analytical Cellular Pathology
%D 2014
%R 10.1155/2014/526979
%X 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 (). 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 (). 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 (). 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. 1. Introduction Nonalcoholic fatty liver disease (NAFLD) is a clinicopathological entity that could be the main cause of chronic liver disease in the coming decades [1]. It is closely associated with states of insulin resistance such as obesity, hyperlipidemia, and type II diabetes. The morphological features of NAFLD range from simple steatosis, which frequently has a benign course, to nonalcoholic steatohepatitis (NASH) with or without fibrosis that may progress to cirrhosis [2]. Although some noninvasive biomarkers have been developed to establish diagnosis and evaluate fibrosis [3¨C5], liver biopsy remains the main tool for confirming the NASH diagnosis and also to provide information about its prognosis. In 1980, Ludwig et al. were the first to recognize nonalcoholic steatohepatitis as a histological entity, very similar to the one already known in the liver from patients with alcohol abuse [6]. Almost two decades later, Matteoni et al. proposed a histological system for NAFLD that classified the biopsies into four subgroups based on the following features: steatosis, necroinflammatory lesions, ballooning, Mallory-Denk hyaline, and fibrosis [7]. Types 1 and 2 were histological forms of
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