Table 12.
NAFLD Pathology Report Example
| Biopsy length |
| •The number of portal areas: |
| •Biopsy adequacy (adequate/limited/inadequate) |
| Morphological findings |
| Morphological findings that must be included in the report: |
| •Macrosteatosis: No/Present |
| Ratio (%) |
| Zonal distribution pattern (zone-3 / zone-1 / azonal / panacinar) |
| •Ballooning degeneration: No/Present |
| Non-classical BD / classical BD |
| Few/many |
| Zonal distribution pattern (zone-3 / zone-1 / azonal) |
| •Lobular inflammation: No/Present |
| Number: Total number of apoptosis, focal necrosis, microgranuloma, and lipogranuloma lobule or x200 |
| Zonal distribution pattern |
| Microgranuloma and/or lipogranuloma: No / present |
| Apoptosis: No/yes |
| •Portal inflammation and interface hepatitis activity: No/Present* |
| Severity: Mild/moderate/pronounced |
| •Fibrosis: No/Present |
| Pericentral sinusoidal fibrosis: Mild/pronounced |
| Periportal sinusoidal fibrosis |
| Portal fibrosis |
| Septa formation: central-central/porto-central/porto-portal |
| Nodulation: Incomplete/complete |
| Suggested (optional) morphological findings to be included in the report |
| •Iron accumulation: None/Present |
| •Microsteatosis: No/Present |
| •Megamitochondria: Absent/Present |
| •Mallory-Denk bodies: None/Present |
| •Glycogenized nucleus: No/Present |
| Diagnosis |
| Fatty liver disease/NAFLD |
| Histological pattern |
| •Steatosis (NAFL) |
| •Steatosis with inflammation |
| •SH (NASH) |
| •SH (NASH), showing acinar zone-1 distribution |
| •Possible NASH (indicating Zone-3 distribution)** |
| •Steatofibrosis** |
| •Sthatohepatitis-related advanced fibrosis (Cirrhosis) |
| •Advanced fibrosis (Cirrhosis)*** |
| Grading and staging |
| Scoring systems that should be included in the report |
| •NAFLD Activity Score |
| •NAFL-CRN Staging System |
| •SAF Score |
| Concomitant pathology |
| •Dysplasia/early HCC: None/Present |
| •Chronic liver disease: None/Present |
Treatment responses should be specified in follow-up biopsies. *: Portal inflammation and interface hepatitis activity correlate with clinical course/fibrogenesis. Although not components of the NAS and/or SAF score, they must be specified in the report. **: Morphological patterns that require clinical correlation and can be interpreted with clinical data. ***: Although steatosis is not observed, if morphological findings suggest that it develops on the basis of NASH, the interpretation of “burned-out” NASH can be given in the notes section.