The application of a numerical scoring system for evaluating the histological outcome in patients with chronic hepatitis B followed in long term

Authors

  • Gudrun Lindh M.D.,

    Corresponding author
    1. Department of Infectious Diseases, Karolinska Institute, Roslagstull Hospital, S-114 89 Stockholm, Sweden
    2. Department of Pathology, Karolinska Institute, Huddinge University Hospital, S-141 86 Huddinge, Sweden
    • Department of Infectious Diseases, Karolinska Institute, Roslagstull Hospital, Box 5651, S-114 89 Stockholm, Sweden
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  • Ola Weiland,

    1. Department of Infectious Diseases, Karolinska Institute, Roslagstull Hospital, S-114 89 Stockholm, Sweden
    2. Department of Pathology, Karolinska Institute, Huddinge University Hospital, S-141 86 Huddinge, Sweden
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  • Hans Glaumann

    1. Department of Infectious Diseases, Karolinska Institute, Roslagstull Hospital, S-114 89 Stockholm, Sweden
    2. Department of Pathology, Karolinska Institute, Huddinge University Hospital, S-141 86 Huddinge, Sweden
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Abstract

A numerical scoring system was applied and compared with conventional histological classification to assess the histological outcome in 42 patients with chronic hepatitis B followed for 16 to 162 months (mean = 75 months). Four histological categories in the biopsies were assessed and scored: (i) piecemeal necrosis; (ii) lobular necrosis; (iii) portal inflammation, and (iv) fibrosis and cirrhosis. The sum of all four categories was defined as the “Histological Activity Index.” Altogether, 102 liver specimens, including 2 to 4 repeats from each patient, were investigated. A good correlation was noted between a high value of the Histological Activity Index score and several liver histology as monitored by conventional terminology for chronic hepatitis. Among patients, with HBeAg persistence, 8 of 14 (57%) deteriorated during follow-up as judged by an increase in the Histological Activity Index score compared to 3 of 13 (23%) of the patients with HBeAg seroconversion (0.5 < p < 0.1). Piecemeal necrosis has been postulated to be a predictive marker for the eventual development of cirrhosis. Here, we found that a low score for piecemeal necrosis in the initial liver biopsy was significantly less predictive of a high fibrosis score in the follow-up biopsy than was a high score for initial piecemeal necrosis (p < 0.001).

It is concluded that the scoring system used can be applied to monitor the histological long-term follow-up, especially when separated into its four constituent categories. It also offers a means of predicting a chronic hepatitis outcome.

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