Quantitative assessment of fibrosis and steatosis in liver biopsies from patients with chronic hepatitis C

Zaitoun, Abed; Mardini, Hanan Al; Awad, Selmy; Ukabam, S.O.; Makadisi, S; Record, C. O.

doi:10.1136/jcp.54.6.461

Cited by 87 publications

(76 citation statements)

References 30 publications

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“…6,7,15 The technique is simple and can be performed either by feeding images into the computer and use an overlay lattice as in this study or supplying one eye-piece of the microscope with a graticule with a point lattice and do the counting directly in the microscope. Different structures in the liver are identified immediately and can be included or excluded from counting.…”

Section: Discussionmentioning

confidence: 99%

Semiquantitative evaluation overestimates the degree of steatosis in liver biopsies: a comparison to stereological point counting

et al. 2005

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The degree of steatosis in liver biopsies is usually assessed by a morphological semiquantitative approach in which the histopathologist uses a four-graded scale: 0-3 or none, slight, moderate and severe. Scores 1-3 are considered to correspond to fat deposition in o33, 33-66 and 466% of the hepatocytes. There is a considerable inter-and intra-individual variation in such scoring methods and a more standardized and quantitative approach is preferable. In the present study, we compare the semiquantitative technique with the stereological point counting method in the assessment of hepatic steatosis. A total of 75 archived liver needle biopsies were used. They were selected according to the original routine diagnosis of slight, moderate or severe steatosis. In all, 10 randomly selected images from each biopsy were digitized into a computer, a point grid lattice was superimposed and the number of hits on fat globules was counted. A pathologist scored the specimens in a four-graded scale as described above. The mean liver biopsy area (volume) with fat in hepatocytes was 2.2% for grade 1, 9.2% for grade 2 and 23.1% for grade 3. The kappa value for the semiquantitative estimates was 0.71 for the unweigthed kappa and 0.87 for weighted kappa. The intraclass correlation coefficient (ICC) was 0.99 for images counted twice and 0.95 when two sets of images were captured from the same biopsy. These ICCs indicate excellent agreement and above that of the semiquantitative estimates. In conclusion, the area/volume of fat content of the hepatocytes is greatly overemphasized in semiquantitative estimation. Furthermore, the point counting technique has a better reproducibility than visual evaluation and should be preferred in estimates of liver steatosis in scientific studies and in clinical contexts when the amount of steatosis is important for treatment and prognosis, such as liver transplantation. Modern Pathology (2005) 18, 912-916.

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Section: Discussionmentioning

confidence: 99%

Semiquantitative evaluation overestimates the degree of steatosis in liver biopsies: a comparison to stereological point counting

et al. 2005

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“…16 However, hepatitis C infection and alcoholic liver injury can be readily distinguished from each other when each is studied separately. [17][18][19] When NASH or alcohol-related injury is superimposed on HCV-related injury, a situation commonly encountered in the obese, diabetic, or alcoholic patient with HCV, histologic changes have not been well described. Given our study population, which included diabetic patients and alcohol drinkers, we were able to address histologic manifestations of these multiple potential causes of liver injury.…”

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confidence: 99%

Steatosis in chronic hepatitis C: Relative contributions of obesity, diabetes mellitus, and alcohol

et al. 2002

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Steatosis has emerged as a histologic finding of importance to the progression of hepatitis C virus (HCV)-associated liver disease. However, most studies of HCV-associated steatosis have excluded alcohol drinkers and individuals with diabetes and thus have not addressed the relative contribution of known causes of steatosis to liver injury in HCV-associated disease. To address this issue, we studied 297 consecutive patients with HCV who met inclusion criteria. Alcohol consumption, demographics, and serologic tests were correlated with degrees of steatosis and fibrosis on liver biopsy. Liver biopsy specimens were also examined for evidence of significant alcohol or nonalcoholic steatohepatitis (NASH) injury. In univariate analysis, steatosis correlated with type 2 diabetes mellitus (P ‫؍‬ .005) and body mass index (BMI) (P ‫؍‬ .0001) but not with the intensity of alcohol intake (in grams per day). In multivariate analysis, BMI (P ‫؍‬ .0002) and genotype 3a infection (P ‫؍‬ .02) were independent predictors of steatosis. When patients with risk factors for NASH were excluded, genotype 3a infection was the only independent predictor of steatosis. Steatosis (P ‫؍‬ .04) and inflammation (P < .0001) scores on liver biopsy were the only independent predictors of fibrosis. Significant alcohol or NASH injury was found in only 6% of biopsy specimens. In conclusion, steatosis in HCV infection is associated with risk factors for NASH, particularly obesity, rather than alcohol consumption. (HEPATOLOGY 2002;36:729-736.)

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“…Such a refinement guaranteed by the measurement procedures proposed in this paper represents a major progress in the qualitative analysis of microscopic images, compared to the techniques using Weibel grids, as in [5,[27][28][29][30]. The precision of the measurements is also very important for the relevance of the probabilistic interpretations, in the sense of detailing the characteristics of statistic populations.…”

Section: Discussionmentioning

confidence: 99%

Highly effective techniques in computerized dental tissue morphometry

Căruntu¹

2002

J Cellular Molecular Medi

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The effectiveness of computer‐aided morphometry is greatly dependent of the capabilities of the software platforms, but the literatutre provides only information about the measurement methods and thier medical interpretation. The purpose of our work is to create a link between the technical algorithm and the medical significance, by a detialed description of measurement procedures, accompained by the interpretation of thier results. The developmed techniques operate at a pixel level, by deriving a full benefit from the computational resources avilable in the modern software evnvironments for image processing. The approach is built on three illustrative cases, formulated in a large sense, so as to cover classes of general problems, referring to cellular entities and tubular structures in cross and longitudinal section. Specimens belonging to the dentin‐pulp complex were chosen, because they permit a quantitiative analysis for each morphological element, as well as comparative discussion. With appropriate adaptations of the procedures, the measurements of other types of normal and pathological tissues and be analogously addressd. The design, implementation and exploittion of our procedures are supported by specific references to the use of an image analysis system (Zeiss KS400). The algorithmic background remains valid (except for some possible minor changes) when similar software is used. Consequently, the results and thier interpretations, prove the importance of the numerical analysis in automating the quantitative evaluation of the structural features.

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Quantitative assessment of fibrosis and steatosis in liver biopsies from patients with chronic hepatitis C

Cited by 87 publications

References 30 publications

Semiquantitative evaluation overestimates the degree of steatosis in liver biopsies: a comparison to stereological point counting

Semiquantitative evaluation overestimates the degree of steatosis in liver biopsies: a comparison to stereological point counting

Steatosis in chronic hepatitis C: Relative contributions of obesity, diabetes mellitus, and alcohol

Highly effective techniques in computerized dental tissue morphometry

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