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Stevenson M, Lloyd-Jones M, Morgan MY, et al. Non-Invasive Diagnostic Assessment Tools for the Detection of Liver Fibrosis in Patients with Suspected Alcohol-Related Liver Disease: A Systematic Review and Economic Evaluation. Southampton (UK): NIHR Journals Library; 2012 Feb. (Health Technology Assessment, No. 16.4.)

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Non-Invasive Diagnostic Assessment Tools for the Detection of Liver Fibrosis in Patients with Suspected Alcohol-Related Liver Disease: A Systematic Review and Economic Evaluation.

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Appendix 1Categorisation of disease progression as identified by liver biopsy

In chronic liver disease, the liver may be affected by inflammation or fibrosis or both. The term ‘grading’ is conventionally used to describe the degree of inflammatory activity, whereas the term ‘staging’ is used to describe the degree of fibrosis and also architectural change.15

A number of systems have been developed to measure and categorise these factors as identified by liver biopsy. These include the Knodell Histological Activity Index (HAI),164 the Ishak-modified HAI,165 and the Scheuer,166 Batts–Ludwig,134 Brunt,137 and METAVIR133 scoring systems. Some of these were developed for chronic liver disease of a specific aetiology, for example Brunt137 and Kleiner136 for NAFLD and METAVIR for hepatitis C.94

The studies reviewed in this report that evaluated the test accuracy of NILTs using liver biopsy as their reference standard most commonly used the METAVIR staging system to measure the degree of fibrosis; however, some used other systems. For comparative purposes, the staging systems used in the included studies are summarised in Table 36. It should be noted that, although the staging systems have numeric labels that imply a linear increase in fibrosis severity between stages, they are in fact ordinal. In other words, although the stages follow a logical ordering in terms of disease severity, they do not represent an underlying continuous scale of measurement such that equal differences between values in the scale represent equivalent differences in the degree of fibrosis (so, for instance, METAVIR stage F4 does not indicate twice as much fibrosis as METAVIR stage F2). However, the degree of fibrosis is a continuous variable and the non-invasive tests reviewed in this report measure continuous variables (serum biochemical markers or liver stiffness) yielding results that may occur at any point on the relevant scale.

TABLE 36. Fibrosis staging systems used in included studies.

TABLE 36

Fibrosis staging systems used in included studies.

© 2012, Crown Copyright.

Included under terms of UK Non-commercial Government License.

Bookshelf ID: NBK97518

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