Updates in the quantitative assessment of liver fibrosis for nonalcoholic fatty liver disease: Histological perspective
Nonalcoholic fatty liver disease/nonalcoholic steatohepatitis (NAFLD/NASH) is a major cause of liver fibrosis and cirrhosis. Accurate assessment of liver fibrosis is important for predicting disease outcomes and assessing therapeutic response in clinical practice and clinical trials. Although noninv...
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| Format: | Article |
| Language: | English |
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Korean Association for the Study of the Liver
2021-01-01
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| Series: | Clinical and Molecular Hepatology |
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| Online Access: | http://e-cmh.org/upload/pdf/cmh-2020-0181.pdf |
| _version_ | 1819059428873207808 |
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| author | Gwyneth Soon Aileen Wee |
| author_facet | Gwyneth Soon Aileen Wee |
| author_sort | Gwyneth Soon |
| collection | DOAJ |
| description | Nonalcoholic fatty liver disease/nonalcoholic steatohepatitis (NAFLD/NASH) is a major cause of liver fibrosis and cirrhosis. Accurate assessment of liver fibrosis is important for predicting disease outcomes and assessing therapeutic response in clinical practice and clinical trials. Although noninvasive tests such as transient elastography and magnetic resonance elastography are preferred where possible, histological assessment of liver fibrosis via semiquantitative scoring systems remains the current gold standard. Collagen proportionate area provides more granularity by measuring the percentage of fibrosis on a continuous scale, but is limited by the absence of architectural input. Although not yet used in routine clinical practice, advances in second harmonic generation/two-photon excitation fluorescence (SHG/TPEF) microscopy imaging show great promise in characterising architectural features of fibrosis at the individual collagen fiber level. Quantification and calculation of different detailed variables of collagen fibers can be used to establish algorithm-based quantitative fibrosis scores (e.g., qFibrosis, q-FPs), which have been validated against fibrosis stage in NAFLD. Artificial intelligence is being explored to further refine and develop quantitative fibrosis scoring methods. SHG-microscopy shows promise as the new gold standard for the quantitative measurement of liver fibrosis. This has reaffirmed the pivotal role of the liver biopsy in fibrosis assessment in NAFLD, at least for the near-future. The ability of SHG-derived algorithms to intuitively detect subtle nuances in liver fibrosis changes over a continuous scale should be employed to redress the efficacy endpoint for fibrosis in NASH clinical trials; this approach may improve the outcomes of the trials evaluating therapeutic response to antifibrotic drugs. |
| first_indexed | 2024-12-21T14:10:57Z |
| format | Article |
| id | doaj.art-6f733b7f15df425f94571a909097ac4a |
| institution | Directory Open Access Journal |
| issn | 2287-2728 2287-285X |
| language | English |
| last_indexed | 2024-12-21T14:10:57Z |
| publishDate | 2021-01-01 |
| publisher | Korean Association for the Study of the Liver |
| record_format | Article |
| series | Clinical and Molecular Hepatology |
| spelling | doaj.art-6f733b7f15df425f94571a909097ac4a2022-12-21T19:01:03ZengKorean Association for the Study of the LiverClinical and Molecular Hepatology2287-27282287-285X2021-01-01271445710.3350/cmh.2020.01811563Updates in the quantitative assessment of liver fibrosis for nonalcoholic fatty liver disease: Histological perspectiveGwyneth Soon0Aileen Wee1 Department of Pathology, National University Hospital, Singapore, Singapore Department of Pathology, National University Hospital, Singapore, SingaporeNonalcoholic fatty liver disease/nonalcoholic steatohepatitis (NAFLD/NASH) is a major cause of liver fibrosis and cirrhosis. Accurate assessment of liver fibrosis is important for predicting disease outcomes and assessing therapeutic response in clinical practice and clinical trials. Although noninvasive tests such as transient elastography and magnetic resonance elastography are preferred where possible, histological assessment of liver fibrosis via semiquantitative scoring systems remains the current gold standard. Collagen proportionate area provides more granularity by measuring the percentage of fibrosis on a continuous scale, but is limited by the absence of architectural input. Although not yet used in routine clinical practice, advances in second harmonic generation/two-photon excitation fluorescence (SHG/TPEF) microscopy imaging show great promise in characterising architectural features of fibrosis at the individual collagen fiber level. Quantification and calculation of different detailed variables of collagen fibers can be used to establish algorithm-based quantitative fibrosis scores (e.g., qFibrosis, q-FPs), which have been validated against fibrosis stage in NAFLD. Artificial intelligence is being explored to further refine and develop quantitative fibrosis scoring methods. SHG-microscopy shows promise as the new gold standard for the quantitative measurement of liver fibrosis. This has reaffirmed the pivotal role of the liver biopsy in fibrosis assessment in NAFLD, at least for the near-future. The ability of SHG-derived algorithms to intuitively detect subtle nuances in liver fibrosis changes over a continuous scale should be employed to redress the efficacy endpoint for fibrosis in NASH clinical trials; this approach may improve the outcomes of the trials evaluating therapeutic response to antifibrotic drugs.http://e-cmh.org/upload/pdf/cmh-2020-0181.pdfnonalcoholic fatty liver diseasefibrosisbiopsy |
| spellingShingle | Gwyneth Soon Aileen Wee Updates in the quantitative assessment of liver fibrosis for nonalcoholic fatty liver disease: Histological perspective Clinical and Molecular Hepatology nonalcoholic fatty liver disease fibrosis biopsy |
| title | Updates in the quantitative assessment of liver fibrosis for nonalcoholic fatty liver disease: Histological perspective |
| title_full | Updates in the quantitative assessment of liver fibrosis for nonalcoholic fatty liver disease: Histological perspective |
| title_fullStr | Updates in the quantitative assessment of liver fibrosis for nonalcoholic fatty liver disease: Histological perspective |
| title_full_unstemmed | Updates in the quantitative assessment of liver fibrosis for nonalcoholic fatty liver disease: Histological perspective |
| title_short | Updates in the quantitative assessment of liver fibrosis for nonalcoholic fatty liver disease: Histological perspective |
| title_sort | updates in the quantitative assessment of liver fibrosis for nonalcoholic fatty liver disease histological perspective |
| topic | nonalcoholic fatty liver disease fibrosis biopsy |
| url | http://e-cmh.org/upload/pdf/cmh-2020-0181.pdf |
| work_keys_str_mv | AT gwynethsoon updatesinthequantitativeassessmentofliverfibrosisfornonalcoholicfattyliverdiseasehistologicalperspective AT aileenwee updatesinthequantitativeassessmentofliverfibrosisfornonalcoholicfattyliverdiseasehistologicalperspective |