Health On the Net Foundation Grading of liver biopsies: systems

  • System adapted from Ludwig, 1993
    Portal and Lobular Inflammatory Activity
    0 None or minimal portal inflammation, no necrosis
    1 Portal inflammation (chronic persistent hepatitis) without necrosis and/or lobular inflammation without evidence of necrosis.
    2 Mild limiting plate necrosis (mild chronic active hepatitis) and/or focal lobular necrosis.
    3 Moderate limiting plate necrosis (moderate CAH) and/or severe focal cell damage.
    4 Severe limiting plate necrosis (severe CAH) and/or bridging necrosis.
    Stage 1 No fibrosis or confined to enlarged portal zones.
    Stage 2 Periportal or portal-portal septa but intact architecture.
    Stage 3 Septal- fibrosis with architectural distortion; no obvious cirrhosis.
    Stage 4 Probable or definite cirrhosis.

  • System adapted from Ishak, et al, 1995

    Necroinflammatory Scores
    Score Pathology
    A. Periportal or periseptal interface hepatitis (piecemeal necrosis)
    0 Absent
    1 Mild (focal, few portal areas)
    2 Mild/moderate (focal, most portal areas)
    3 Moderate (around <50% of tracts or septa)
    4 Severe (continuous around >50% of tracts or septa)
    B. Confluent necrosis
    0 Absent
    1 Focal confluent necrosis
    2 Zone 3 necrosis in some areas
    3 Zone 3 necrosis in most areas
    4 Zone 3 necrosis, plus occasional
    5 Zone 3 necrosis, plus multiple P-C bridging
    6 Panacinar or multiacinar necrosis
    C. Focal (spotty) lytic necrosis, apoptosis and focal inflammation
    0 Absent
    1 One focus or less per 1Ox objective (ob)
    2 Two to four foci per 10x ob
    3 Five to ten foci per 10x ob
    4 More than ten foci per 10x ob
    D. Portal inflammation
    0 None
    1 Mild, some or all portal areas
    2 Moderate, some or all portal areas
    3 Moderate/marked, all portal areas
    4 Marked, all portal area
    Architectural Changes, Fibrosis/Cirrhosis
    0 No fibrosis
    1 Fibrous expansion of some portal areas, with or without short fibrous septa
    2 Fibrous expansion of most portal areas, with or without short fibrous septa
    3 Fibrous expansion of most portal areas with occasional portal to portal (P-P) bridging
    4 Fibrous expansion of portal areas with marked bridging (P-P as well as P-C)
    5 Marked bridging (P-P and/or P-C) with occasional nodules (incomplete cirrhosis)
    6 Cirrhosis, probable or definite



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    Last modified: Fri Mar 21 1997