An Assessment of Digital Image Analysis to Measure Fibrosis in Liver Biopsy Specimens of Patients With Chronic Hepatitis C

Abstract

The aim was to assess the validity of a digitally computed fibrosis ratio as a measure of fibrosis stage in liver biopsy specimens. We scored 230 liver biopsy specimens from patients with chronic hepatitis C for fibrosis using modified Knodell criteria; fibrosis ratios were computed from digital images that encompassed the complete trichrome-stained section of each case. Although an overall correlation between fibrosis ratio and ordinal score was present, subset analysis showed that this correlation existed only among biopsy specimens with high scores (3-6, early bridging fibrosis to established cirrhosis). There was no correlation or difference between category means found among biopsy specimens with low scores (0-3, normal to early bridging fibrosis). Furthermore, concordance by both estimates in direction of fibrosis change among serial liver biopsy specimens was found in only 11 (30%) of 37 pairs compared. The findings suggest that a qualitative assessment of the computerized fibrosis pattern is necessary for the interpretation of computerized fibrosis ratio measurements, particularly in patients with early stage fibrosis.

Progression of fibrosis in advanced chronic hepatitis C: Evaluation by morphometric image analysis

“…6,13 This approach necessarily assumes that each patient arrived at the stage on the day of the biopsy, whereas it may actually have been years earlier, and it also assumes that the categories represented by the numbers of the scores are equal distance apart in terms of severity, amount of fibrous tissue, or time of development, none of which is supported by strong evidence. Indeed, our data, as well as those of O'Brien et al, 22 have shown that in fact there is a great deal of overlap between the various stages of scoring systems in the amount of fibrous tissue measured in the biopsies. Thus, a progression through histologic stages is not necessarily the same as an increase in fibrosis.…”

“…Although the methodology is not standardized, a number of publications have described methods for quantifying hepatic fibrosis by image analysis, and all appear to yield similar results. 5,[18][19][20][21][22][23][24][25][26][27] The methods are time consuming compared with simple histologic scoring, and the necessary equipment and expertise are not widely available, but in a study to evaluate progression or regression of fibrosis, measuring the amount of fibrosis as precisely as possible seems appropriate.…”

Magnetic resonance imaging of hepatic fibrosis: Emerging clinical applications

“…Finally, these limitations make reliable and valid serial assessments to document progressive fibrosis nearly impossible to perform. 11 Although computerized image analysis protocols may offer the potential for quantitative analysis of liver fibrosis, 12 this method requires further study to provide standardized approaches to ensure reliability. 13 Ultimately, the method of percutaneous liver biopsy is an invasive procedure with poor acceptance by patients.…”

“…11,12 Most current imaging strategies looking at fibrosis, however, have been unable to decipher these histological correlates separately. 15 Serum Markers.…”

Asian-Pacific Association for the Study of the Liver (APASL) consensus guidelines on invasive and non-invasive assessment of hepatic fibrosis: a 2016 update

“…Image analysis studies have looked at fibrosis in many conditions, producing overall similar results ranging from 1 to 4 % fibrous tissue in normal liver to 15-35 % fibrous tissue in cirrhosis [60]. CPA correlates well with late stages of fibrosis, but is highly sensitive to sample size [43].…”