Proposal of a new staging and grading system of the liver for primary biliary cirrhosis

Abstract

Aims: In this study, we attempted to define a new histological staging and grading system to provide more information reflecting the clinical laboratory data and prognosis to hepatologists. Methods and Results: First, 17 histological lesions of primary biliary cirrhosis (PBC) were scored in 188 needle liver biopsy specimens. Factor analysis yielded three independent groups of factors: Factor 1 (fibrosis, fibrous piecemeal necrosis, orcein positive granules, bile plugs, Mallory bodies, feathery degeneration, bile duct loss and atypical ductular proliferation); Factor 2 (portal inflammation, eosinophilic infiltration, lymphoid follicle, epithelioid granuloma, interface hepatitis and chronic cholangitis); and Factor 3 (interface hepatitis, lobular hepatitis, acidophilic bodies and pigmented macrophages). Eight findings of Factor 1, but not Factors 2 and 3, were significantly correlated with the clinical laboratory data and scores of Mayo's prognostic model. Factor 1 lesions may reflect the histological progression (staging), while Factor 2 and 3 lesions may relate to necroinflammatory activities (grading). Then, we devised a staging and grading system using three lesions (bile duct loss, fibrosis and orcein positive granules) from Factor 1 and three from Factors 2 and 3 (chronic cholangitis, interface hepatitis and lobular hepatitis). This new system might provide more pathological information of PBC patients to hepatologists. Hiramatsu -4-

Biochemical and Histological Effectiveness of Long-term Use of Fenofibrate for Asymptomatic Primary Biliary Cholangitis

“…With regard to the histological evaluations of the liver, we used Scheuer's staging system [23] and Nakanuma's staging and grading system [24,25] . Histological examinations were performed at the initial administration of fenofibrate and 22-39 months after the start of the fenofibrate therapy in five cases.…”

“…The findings of liver biopsies performed at the initiation of fenofibrate and approximately two and a half years (22-39 months) after fenofibrate administration were compared in the five patients with aPBC. Histological evaluations of aPBC were made using Scheuer's classification [23] (stage 1: a damaged bile ducts surrounded by chronic inflammatory cells or florid ductal lesion, stage 2: abnormal proliferating bile ductules without a duct lumen, the disappearance of normal bile ducts, and extension of portal inflammation into the hepatic parenchyma, stage 3: substantially increased fibrosis and fibrous septa formation and stage 4: cirrhosis with regenerative nodules) in combination with Nakanuma's classification [24,25] (stage 1 (no progression): score 0 fibrosis and bile duct loss, stage 2 (mild progression): score 1-2 fibrosis and bile duct loss, stage 3 (moderate progression): score 3-4 fibrosis and bile duct loss, and stage 4 (advanced progression): score 5-6 fibrosis and bile duct loss; cholangitis activity (CA), 0: no activity, 1: mild activity, 2: moderate activity and 3: marked activity; and hepatitis activity (HA), 0: no activity, 1: mild activity, 2: moderate activity and 3: marked activity). The assessment of the effects of adding fibrate to UDCA was performed in accordance with the ethical guidelines of the Declaration of Helsinki and the study protocol approved by the Chihaya Hospital Ethics Committee.…”

Evaluation of a new histologic staging and grading system for primary biliary cirrhosis in comparison with classical systems

“…Y. Kakuda et al Table Table 1 Y. Kakuda et al Table Table 2. Grading of the necroinflammatory activity of primary biliary cirrhosis IgM (mean ± SD, mg/dL) 376 ± 267 370 ± 280 (a Cases which had not been used in our previous study (6 …”

“…We found different We then analyzed PBC patients before UDCA therapy with respect to clinicolaboratory and histological findings using the 3 staging systems. In this evaluation, the patients who had been used as cases for our previous study (6), in which the new grading and staging system had been proposed, were excluded. The new system and the 2 classical systems were found to correlate well with Alp, γ-GTP, AST, and ALT levels.…”

“…Herein, we excluded the 42 patients used as cases for the previous study in which this new grading and staging system had been proposed (6). Therefore, the remaining 110 cases were evaluated.…”