CONCLUSION:The results are the first standardized metrical evaluation of the geometric properties of the parenchyma, inflammation, fibrosis, and alterations in liver tissue tectonics of the biopsy sections. The present study confirms that biopsies are still valuable, not only for diagnosing chronic hepatitis, but also for quantifying changes in the organization and order of liver tissue structure.
INTRODUCTIONThe main purpose of this paper is to describe a rigorous method based on the fundamentals of measurement theory [1] , which metrically defines the changes in magnitude of liver tissue prime basic structural elements that occurring during the course of chronic hepatitis B and C.Each available score to evaluate hepatic lesions is characterized by some methodological inaccuracy [2][3][4] . In fact, transient elastography (Fibro-Scan) [5,6] is limited by the skill of the operator and because liver stiffness is not only dependent from fibrosis, and serological assays not directly involved in tissue evolution, but in patient diagnosis [7][8][9][10][11] . In addition to the inherent risks of excising a liver specimen [12] , current morphometric analyses [13][14][15][16][17] are timeconsuming, depend on subjective choices of the regions of interest, involve the interactive elimination of Glisson's capsule and staining artefacts, and use the International System (IS), which is unsuitable for measuring the irregular shapes found in histology [18][19][20][21] . The study concerning the status of the liver tissue affected by chronic viral hepatitis was suggested by three
Abstract
AIM:To describe a quantitative analysis method for liver biopsy sections with a machine that we have named "Dioguardi Histological Metriser" which automatically measures the residual hepatocyte mass (including hepatocytes vacuolization), inflammation, fibrosis and the loss of liver tissue tectonics. METHODS: We analysed digitized images of liver biopsy sections taken from 398 patients. The analysis with Dioguardi Histological Metriser was validated by comparison with semi-quantitative scoring system. RESULTS: The method provides: (1) the metrical extension in two-dimensions (the plane) of the residual hepatocellular set, including the area of vacuoles pertinent to abnormal lipid accumulation; (2) the geometric measure of the inflammation basin, which distinguishes intra-basin space and extra-basin dispersed parenchymal leukocytes; (3) the magnitude of collagen islets, (which were considered truncated fractals and classified into three degrees of magnitude); and (4) the tectonic index that quantifies alterations (disorders) in the organization of liver tissue. Dioguardi Histological Metriser machine allows to work at a speed of 0.1 mm 2 /s, scanning a whole section in 6-8 min.