Role of liver biopsy in nonalcoholic fatty liver disease.
- 21 July 2014
- journal article
- review article
- Published by Baishideng Publishing Group Inc. in World Journal of Gastroenterology
- Vol. 20 (27), 9026-37
- https://doi.org/10.3748/wjg.v20.i27.9026
Abstract
Nonalcoholic fatty liver disease (NAFLD), defined as abnormal accumulation (> 5%) of hepatic triglyceride without excess alcohol intake, is the most common form of chronic liver disease in adults and children in the United States. NAFLD encompasses a spectrum of histologic findings including uncomplicated steatosis, steatosis with inflammation and steatohepatitis [nonalcoholic steatohepatitis (NASH)]; the latter can advance to cirrhosis and hepatocellular carcinoma. NASH is currently accepted as the hepatic manifestation of the set of cardiovascular risk factors collectively known as metabolic syndrome. In 1999 a system for histologic grading and staging for NASH was proposed; this was revised by the NASH Clinical Research Network in 2005 for the entire spectrum of lesions in NAFLD, including the lesions and patterns of pediatric NAFLD, and for application in clinical research trials. Diagnosis remains distinct from grade and stage. A recent European proposal separates steatosis from activity to derive a numeric diagnosis of NASH. Even though there have been promising advancements in non-invasive testing, these tests are not yet detailed enough to replace the full range of findings provided by liver biopsy evaluation. Limitations of biopsy are acknowledged, but liver biopsy remains the "gold standard" for diagnosis and determination of amounts of necroinflammatory activity, and location of fibrosis, as well as remodeling of the parenchyma in NASH. This review focuses on the specific histologic lesions of NAFLD and NASH, grading and staging, differential diagnoses to be considered, and the continuing role of the liver biopsy in this important liver disease.Keywords
This publication has 100 references indexed in Scilit:
- Costaining for keratins 8/18 plus ubiquitin improves detection of hepatocyte injury in nonalcoholic fatty liver diseaseHuman Pathology, 2012
- Serum ferritin is an independent predictor of histologic severity and advanced fibrosis in patients with nonalcoholic fatty liver diseaseHepatology, 2011
- Nonalcoholic fatty liver disease (NAFLD) activity score and the histopathologic diagnosis in NAFLD: distinct clinicopathologic meaningsHepatology, 2010
- Relationship between the pattern of hepatic iron deposition and histological severity in nonalcoholic fatty liver diseaseHepatology, 2010
- Nonalcoholic steatohepatitis in children: A multicenter clinicopathological studyHepatology, 2009
- Long-Term Follow-Up of Patients With Nonalcoholic Fatty LiverClinical Gastroenterology and Hepatology, 2009
- Portal chronic inflammation in nonalcoholic fatty liver disease (NAFLD): A histologic marker of advanced NAFLD-Clinicopathologic correlations from the nonalcoholic steatohepatitis clinical research networkHepatology, 2008
- Beyond insulin resistance: Innate immunity in nonalcoholic steatohepatitisHepatology, 2008
- Nonalcoholic Fatty Liver Disease: From Steatosis to CirrhosisHepatology, 2006
- Design and validation of a histological scoring system for nonalcoholic fatty liver diseaseHepatology, 2005