There are some common references for this purpose, including the NAS system. It was developed for the classification of the pathology in the research projects for comparing the liver histology from the patients before and after the therapeutic intervention, but nowadays it is used for the diagnosis and differentiation of pure NAFLD from NASH.
Bedossa, P., Poitou, C., Veyrie, N., Bouillot, J.-L., Basdevant, A., Paradis, V., et al. (2012). Histopathological algorithm and scoring system for evaluation of liver lesions in morbidly obese patients. Hepatology (Baltimore, Md). doi:10.1002/hep.25889
Dear Stefan
This is right that the NAS score is used for the diagnosis of NAFLD and NASH; but as you correctly mentioned it was originally developed for the followup of the patients during therapeutic trials for these NAFLD/NASH patients. The developers themselves did not develop it for the primary diagnosis of the entity. As I had a personal communication with them, this is their opinion.
Dear Iradj,
the new SAF score I quoted should deal much better with the problem we have/had with the NAS regarding diagnosis of NASH.
Dear Stefan:
Could you send me a copy of the SAF score, the manuscript probably?
Thanks
The main question is nonalcoholic fatty liver disease is a benign form or progressive type? The gold standard in order to obtain this diagnosis is represented by liver biopsy. To date, histological assessment of liver steatosis, ballooning, lobular inflammation in H&E staining coupled to fibrosis detection is considered the best tool for diagnosis of NASH. Independent histological predictors of progression on index biopsy were the presence of mixed macro/micro vesicular fat and of giant mitochondria.
I strongly agree that a differential diagnosis between the two conditions cannot be separated from histology.
Dear Ierardi:
Which scoring system for pathological staging are you using in your ward?
I think that the problem is not the pathological score of fibrosis and inflammation, but the presence/absence of microscopic features of chronic hepatitis in order to differentiate NASH from NAFLD. This aspect may be relevant for the different prognostic value of the two conditions.
Dear Vincent:
Thanks for your reply. I think that the above mentioned criteria cannot be used for the diagnosis. As I had a personnel contact with the first 2 great authors, they mentioned that NAS score was designed for the follow up of pathologic changes of liver during treatment, not mainly for the primary diagnosis.
And there are also some reports on the inter and intra-observer variation in pathologic reports as well.
How can we clinicians solve the problem with the aid of pathologists?
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