Non-alcoholic fatty liver disease other diagnostic studies

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

Liver biopsy may be helpful in the diagnosis of non-alcoholic fatty liver disease. Findings on biopsy include macrovesicular steatosis, inflammation, ballooning degeneration, zone 3 perivenular/periportal/perisinusoidal fibrosis and, finally, mallory bodies.

Other Diagnostic Studies

  • Liver biopsy is considered as a gold-standard for diagnosing, grading, and staging NAFLD.
  • Invasive test
  • Associated with significant bleeding risk in patients with clotting abnormalities due to hepatic disease.

Complications

Complications of liver biopsy are rare but include

Findings

Classically, biopsy reveals:[1][2]

Interpretation

Histo-pathological classification

Depending on degree of steatosis, necroinflammatory activity, and degree of fibrosis non-alcoholic liver disease can be classified as follows:

Grading

NAFLD activity score is employed for grading steatohepatitis of NASH. NAS represents the sum of scores for steatosis, lobular inflammation, and ballooning.[4]

Component Range Score
Steatosis <5% 0
5-33% 1
34-66% 2
>66% 3
Lobular Inflammation None 0
<2 focci 1
2-4 2
>4 3
Hepatocyte Balloning None 0
Few ballooned cells 1
Many ballooned cells 2
Interpretation 0-2 Non-diagnostic
3-4 Borderline
5-8 Diagnostic

Staging

Based on the degree of fibrosis on biospy NASH can be classified into 4 stages.

Staging
Stage 1

Zone 3 fibrosis
Perisinusoidal fibrosis
Portal/ periportal fibrosis

Stage 2 Perisinusoidal and portal/periportal fibrosis
Stage 3 Bridging fibrosis
Stage 4 Cirrhosis

References

  1. Angula P. Nonalcoholic Fatty Liver Disease. NEJM. 2002 346(16):1221-31
  2. Brunt EM, Janney CG, Di Bisceglie AM et al. Nonalcoholic steatohepatitis: A proposal for grading and staging the histological lesions. Am. J. Gastroenterol. 1999; 94(9):2467-2474
  3. Skelly et al. Findings on liver biopsy to investigate abnormal liver function tests in the absence of diagnostic serology. J Hepatol 2001;35:195-9
  4. Vizuete J, Camero A, Malakouti M, Garapati K, Gutierrez J (2017). "Perspectives on Nonalcoholic Fatty Liver Disease: An Overview of Present and Future Therapies". J Clin Transl Hepatol. 5 (1): 67–75. doi:10.14218/JCTH.2016.00061. PMC 5411359. PMID 28507929.

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