A Novel Histologic Scoring System Accurately Identifies Regressed Cirrhosis in Patients with Chronic Viral Hepatitis Otherwise Understaged by Both Conventional Histological Fibrosis Staging and Serological Markers of Hepatic Fibrosis
V Pattullo, SE Fischer, JJ Feld, DK Wong, M Guindi. University of Toronto, Toronto, ON, Canada
Background: Cirrhosis may be diagnosed histologically despite fibrosis regression when there is evidence of parenchymal remodelling (PR); hepatoma complicates both overt and regressed cirrhosis. The aim of this study was to evaluate a novel scoring system to identify regressed cirrhosis in the absence of overt advanced fibrosis in liver biopsies of patients with chronic viral hepatitis.
Design: Patients with compensated chronic hepatitis B (CHB) and C (CHC) who had a liver biopsy as well as Fibrotest and APRI were identified from a clinical database. Corresponding clinical measures were recorded (serum albumin, coagulation profile, platelets, serum IgG, splenomegaly, varices and radiological features of portal hypertension). Hepatic fibrosis (Ishak criteria) was scored by 2 blinded pathologists. Cases were categorised as overt cirrhosis (Ishak stage 6, or stage 5 with wide fibrous septa), cirrhosis by parenchymal remodelling (cirrhosis-PR), or no cirrhosis (Ishak stage <5 without PR). Qualitative features of regression were recorded for each case to derive a regression score out of 12. A ROC curve was derived to determine the optimal cut-off regression score which distinguished cirrhotics from non-cirrhotics.
Results: 184 biopsies (79 CHB and 105 CHC) were reviewed (mean biopsy length 2.5+/-0.9cm, mean number portal tracts 21.1+/-7.5). Histological diagnoses of overt cirrhosis (45), cirrhosis-PR (21) and no cirrhosis (118) were made. Fibrotest was significantly higher in overt cirrhosis than no cirrhosis (0.57 vs 0.39, p<0.01), numerically higher in overt cirrhosis compared to cirrhosis-PR (0.57 vs 0.48, p=0.15), but failed to distinguish cirrhosis-PR from no cirrhosis (0.48 vs 0.39, p=0.15). Similarly, APRI, and clinical measures failed to distinguish cirrhosis-PR from no cirrhosis. Mean regression scores in overt cirrhosis (7.82) and cirrhotic-PR (7.52) were higher than that of the non-cirrhotics (2.68, p<0.0001). A cut-off regression score of ≥5 yielded the highest accuracy for diagnosis of cirrhosis (accuracy 83.4%, sensitivity 93.3%, specificity 79.7%, AUROC 0.9036).
Conclusions: Cirrhosis may be present without histologic evidence of overt advanced fibrosis or clinical evidence of cirrhosis. The histologic hepatic fibrosis regression score accurately identifies patients with regressed cirrhosis whereas Fibrotest and APRI do not.
Category: Liver & Pancreas
Monday, March 22, 2010 1:00 PM
Poster Session II # 186, Monday Afternoon