Abstract
The role of liver biopsy in nonalcoholic steatohepatitis (NASH) has evolved along with the increased recognition of the significance of this disease, and the unmet medical need it presents. Drug development and clinical trials are rapidly growing, as are non‐invasive tests for markers of steatosis, inflammation, injury and fibrosis. Liver biopsy evaluation remains necessary for both drug development and clinical trials as the most specific means of diagnosis and patient identification for appropriate intervention.
This White Paper, sponsored by the American Association for the Study of Liver Disease NASH Task Force, is a focused review of liver biopsy evaluation in fatty liver disease in subjects with presumed NAFLD for practicing clinical hepatologists and pathologists. The goal is to provide succinct and specific means for reporting the histopathologic elements of NASH, distinguishing NASH from nonalcoholic fatty liver without steatohepatitis (NAFL), and from alcoholic steatohepatitis when possible. The discussion includes the special situations of NASH in advanced fibrosisor cirrhosis, and in the pediatric population. Finally, there is discussion of semiquantitative methods of evaluation of lesions of "disease activity" and fibrosis. Tables are present for scoring and a suggested model for final reporting. Figures presented highlight the histopathologic elements of NASH.
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