Histopathological algorithm and scoring system for evaluation of liver lesions in morbidly obese patients

Authors

  • Pierre Bedossa,

    Corresponding author
    1. Assistance Publique-Hôpitaux de Paris, Beaujon Hospital, Pathology Department, Clichy, France; Centre de Recherche Bichat-Beaujon, INSERM U773, University Paris-Diderot, Paris, France
    • Department of Pathology, Hôpital Beaujon, 100 Bd general Leclerc, 92100—Clichy, France
    Search for more papers by this author
    • fax: +33140870077

  • Christine Poitou,

    1. Institute of Cardiometabolism and Nutrition, (ICAN), Assistance Publique-Hôpitaux de Paris Pitié-Salpêtrière Hospital, Paris, France
    2. INSERM, U872, Nutriomique, Paris, France; Université Pierre et Marie Curie-Paris6, Centre de Recherche des Cordeliers, UMR S 872, Paris, France
    Search for more papers by this author
  • Nicolas Veyrie,

    1. Assistance Publique-Hôpitaux de Paris, Ambroise Paré Hospital, Surgery Department, Boulogne-Billancourt, France
    Search for more papers by this author
  • Jean-Luc Bouillot,

    1. Assistance Publique-Hôpitaux de Paris, Ambroise Paré Hospital, Surgery Department, Boulogne-Billancourt, France
    Search for more papers by this author
  • Arnaud Basdevant,

    1. Institute of Cardiometabolism and Nutrition, (ICAN), Assistance Publique-Hôpitaux de Paris Pitié-Salpêtrière Hospital, Paris, France
    2. INSERM, U872, Nutriomique, Paris, France; Université Pierre et Marie Curie-Paris6, Centre de Recherche des Cordeliers, UMR S 872, Paris, France
    Search for more papers by this author
  • Valerie Paradis,

    1. Assistance Publique-Hôpitaux de Paris, Beaujon Hospital, Pathology Department, Clichy, France; Centre de Recherche Bichat-Beaujon, INSERM U773, University Paris-Diderot, Paris, France
    Search for more papers by this author
  • Joan Tordjman,

    1. Institute of Cardiometabolism and Nutrition, (ICAN), Assistance Publique-Hôpitaux de Paris Pitié-Salpêtrière Hospital, Paris, France
    2. INSERM, U872, Nutriomique, Paris, France; Université Pierre et Marie Curie-Paris6, Centre de Recherche des Cordeliers, UMR S 872, Paris, France
    Search for more papers by this author
    • These authors contributed equally to this work.

  • Karine Clement

    1. Institute of Cardiometabolism and Nutrition, (ICAN), Assistance Publique-Hôpitaux de Paris Pitié-Salpêtrière Hospital, Paris, France
    2. INSERM, U872, Nutriomique, Paris, France; Université Pierre et Marie Curie-Paris6, Centre de Recherche des Cordeliers, UMR S 872, Paris, France
    Search for more papers by this author
    • These authors contributed equally to this work.


  • Potential conflict of interest: Nothing to report.

  • We thank the Assistance Publique - Hôpitaux de Paris (APHP) and the Direction of Clinical Research, which promoted and supported clinical investigations, the Programme Hospitalier de Recherche Clinique (AOR 02076 to K.C.) and the Contrat de Recherche Clinique (CRC P050318 to C.P.). This work was also supported by the Commission of European Communities (Collaborative Project “Hepatic and adiposetissue and functions in the metabolic syndrome” HEPADIP, seehttp://www.hepadip.org/, contract LSHM-CT-2005-018734). The research leading to these results received funding from the European Union Seventh Framework Program (FP7/2007-2013) under grant agreement no. Health-F2-2009-241762, for the FLIP project.

Abstract

Nonalcoholic fatty liver disease (NAFLD) is highly prevalent and being overweight is a significant risk factor. The aim was to build an algorithm along with a scoring system for histopathologic classification of liver lesions that covers the entire spectrum of lesions in morbidly obese patients. A cohort of 679 obese patients undergoing liver biopsy at the time of bariatric surgery was studied. An algorithm for segregating lesions into normal liver, NAFLD, or nonalcoholic steatohepatitis (NASH) was built based on semiquantitative evaluation of steatosis, hepatocellular ballooning, and lobular inflammation. For each case, the SAF score was created including the semiquantitative scoring of steatosis (S), activity (A), and fibrosis (F). Based on the algorithm, 230 obese patients (34%) were categorized as NASH, 291 (43%) as NAFLD without NASH, and 158 (23%) as not NAFLD. The activity score (ballooning + lobular inflammation) enabled discriminating NASH because all patients with NASH had A ≥ 2, whereas no patients with A < 2 had NASH. This score was closely correlated with both alanine aminotransferase (ALT) and aspartate aminotransferase (AST) (P < 0.0001, analysis of variance [ANOVA]). Comparison of transaminase levels between patients with normal liver and pure steatosis did not reveal significant differences, thus lending support to the proposal not to include steatosis in the activity score but to report it separately in the SAF score. In the validation series, the interobserver agreement for the diagnosis of NASH was excellent (κ = 0.80) between liver pathologists. There was no discrepancy between the initial diagnosis and the diagnosis proposed using the algorithm. Conclusion: We propose a simple but robust algorithm for categorizing liver lesions in NAFLD patients. Because liver lesions in obese patients may display a continuous spectrum of histologic lesions, we suggest describing liver lesions using the SAF score. (HEPATOLOGY 2012;56:1751–1759)

Ancillary