TY - JOUR
T1 - Development of a Scoring System to Differentiate Amiodarone-Induced Liver Injury From Alcoholic Steatohepatitis
AU - González, Iván A.
AU - Fuller, Lanisha D.
AU - Zhang, Xuefeng
AU - Papke, David J.
AU - Zhao, Lei
AU - Zhang, Dongwei
AU - Liao, Xiaoyan
AU - Liu, Xiuli
AU - Fiel, Maria I.
AU - Zhang, Xuchen
N1 - Publisher Copyright:
© 2021 American Society for Clinical Pathology.
PY - 2022/3/1
Y1 - 2022/3/1
N2 - Objectives: Amiodarone-induced liver injury (AILI) is histopathologically similar to alcoholic steatohepatitis (ASH). We sought to elucidate their histologic differences and develop a scoring system to differentiate these two entities. Methods: A cohort of 17 AILI and 17 ASH cases was included in the initial study. Cases from three different institutions were included for further validation. Results: Macrovesicular steatosis was usually below 10% of the liver parenchyma in AILI. Hepatocyte ballooning degeneration was more common in ASH than in AILI. "Balloon-like"hepatocyte was more common in AILI than in ASH. Lobular neutrophilic inflammation, satellitosis, and cholestasis were more common in ASH. Mallory-Denk bodies and pericellular fibrosis in AILI were mainly located in zone 1 compared with a panacinar or zone 3 distribution in ASH. A scoring system was developed in which points were assigned to different histologic features; a total sum of less than 5 suggests AILI, more than 5 is ASH, and 5 is equivocal. This scoring system was then evaluated on a test cohort comprising 14 AILI cases, in which 13 cases were correctly assigned with a score less than 5. The sensitivity, specificity, and accuracy for diagnosing AILI in the test cohort were 92.9%, 91.7%, and 92.3%, respectively. Conclusions: This scoring system can aid pathologists to differentiate AILI from ASH.
AB - Objectives: Amiodarone-induced liver injury (AILI) is histopathologically similar to alcoholic steatohepatitis (ASH). We sought to elucidate their histologic differences and develop a scoring system to differentiate these two entities. Methods: A cohort of 17 AILI and 17 ASH cases was included in the initial study. Cases from three different institutions were included for further validation. Results: Macrovesicular steatosis was usually below 10% of the liver parenchyma in AILI. Hepatocyte ballooning degeneration was more common in ASH than in AILI. "Balloon-like"hepatocyte was more common in AILI than in ASH. Lobular neutrophilic inflammation, satellitosis, and cholestasis were more common in ASH. Mallory-Denk bodies and pericellular fibrosis in AILI were mainly located in zone 1 compared with a panacinar or zone 3 distribution in ASH. A scoring system was developed in which points were assigned to different histologic features; a total sum of less than 5 suggests AILI, more than 5 is ASH, and 5 is equivocal. This scoring system was then evaluated on a test cohort comprising 14 AILI cases, in which 13 cases were correctly assigned with a score less than 5. The sensitivity, specificity, and accuracy for diagnosing AILI in the test cohort were 92.9%, 91.7%, and 92.3%, respectively. Conclusions: This scoring system can aid pathologists to differentiate AILI from ASH.
KW - Alcoholic steatohepatitis
KW - Amiodarone
KW - Drug-induced liver injury
UR - http://www.scopus.com/inward/record.url?scp=85125679331&partnerID=8YFLogxK
U2 - 10.1093/ajcp/aqab142
DO - 10.1093/ajcp/aqab142
M3 - Article
C2 - 34596220
AN - SCOPUS:85125679331
SN - 0002-9173
VL - 157
SP - 434
EP - 442
JO - American journal of clinical pathology
JF - American journal of clinical pathology
IS - 3
ER -