Relationship between Number of Portal Tract Macrophages and the Modified Hepatic Activity Index in Chronic Hepatitis C Infection
MK McElroy, MR Peterson. University of California, San Diego, La Jolla, CA
Background: The Ishak modified hepatic activity index (mHAI) is widely used to score disease activity in chronic hepatitis C. However, the scoring of the mHAI components is subjective and prone to interobserver variation. Liver injury results in increased numbers of portal tract macrophages, which are easily identified via PASD stain. We hypothesize that the number of portal tract macrophages is related to the mHAI in chronic hepatitis C infection, and that this score may provide a quantitative and more reproducible measure of disease activity.
Design: 30 consecutive needle core liver biopsies performed on patients with chronic hepatitis C infection were retrieved, including H&E, PASD, and trichrome stained slides. These biopsies were independently reviewed by two pathologists and scored using the mHAI. The number of portal tract PASD positive macrophages was counted, expressed as the number of macrophages per CM of biopsy length. The macrophage counts were then sorted into the following categories: none, minimal (0-2/CM), mild (2-5/CM), moderate (5-8/CM), and severe (>8/CM). This data was then compared to components of the mHAI.
Results: The number of portal tract PASD positive macrophages was found to be significantly associated with the level of portal inflammation (p=0.039) and total summed mHAI score (p=0.029). The number of portal tract PASD macrophages appeared to be related to the level of interface activity and focal lobular necroinflammatory activity, but these failed to meet significance (p=0.073 and 0.079) in this small study. There was no relationship between portal tract PASD macrophage counts and the level of fibrosis. There was better interobserver agreement for portal tract PASD macrophage counts than any component of the mHAI. Specifically, the kappa coefficient for portal tract PASD macrophage count categories was 0.85, while the kappa coefficient for mHAI components was as follows: portal inflammation 0.55, focal lobular necroinflammatory activity 0.45, and interface activity 0.70.
Conclusions: We conclude that there is a statistically significant relationship between the number of portal tract macrophages and the level of portal inflammation and the total summed mHAI score. In addition, we find better interobserver agreement for portal tract macrophage counts than for any of the mHAI components. This technique may provide a reproducible and useful scoring method as an adjunct to the modified hepatic activity index for assessing the level of disease activity in chronic hepatitis C.
Category: Liver & Pancreas
Monday, March 22, 2010 1:00 PM
Poster Session II # 184, Monday Afternoon