{"id":2343,"date":"2015-06-23T12:47:28","date_gmt":"2015-06-23T12:47:28","guid":{"rendered":"https:\/\/medicalcriteria.com\/web\/hepsscld\/"},"modified":"2026-03-19T21:02:04","modified_gmt":"2026-03-19T21:02:04","slug":"hepsscld","status":"publish","type":"post","link":"https:\/\/medicalcriteria.com\/web\/hepsscld\/","title":{"rendered":"Histologic Scoring Systems for Chronic Liver Disease"},"content":{"rendered":"<div class=\"99c380e4b4a7b96c35d7ddf7dcb434e8\" data-index=\"1\" style=\"float: none; margin:0px 0 0px 0; text-align:center;\">\n<script async src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js\"><\/script>\r\n<!-- MC 2019- Horizontal -->\r\n<ins class=\"adsbygoogle\"\r\n     style=\"display:block\"\r\n     data-ad-client=\"ca-pub-0127150553352455\"\r\n     data-ad-slot=\"3806776041\"\r\n     data-ad-format=\"auto\"\r\n     data-full-width-responsive=\"true\"><\/ins>\r\n<script>\r\n     (adsbygoogle = window.adsbygoogle || []).push({});\r\n<\/script>\n<\/div>\n<p>Grading and staging refers to a semiquantitative assessment of the necroinflammatory activity (grade) and degree of fibrosis (stage) in relation to chronic hepatitis.<br \/>\n<!--more--><br \/>\n<b>Ishak modification for hepatic activity index (HAI) for scoring of necroinflammatory activity in chronic hepatitis<\/b><\/p>\n<table style=\"border-collapse: collapse; width: 100%;\" border=\"1\">\n<tbody>\n<tr>\n<td colspan=\"2\" valign=\"TOP\" width=\"525\"><b>(A) Periportal or periseptal interface hepatitis (piecemeal necrosis)<\/b><\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"457\">Absent<\/td>\n<td style=\"text-align: center;\" width=\"68\">0<\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"457\">Mild (focal, few portal areas)<\/td>\n<td style=\"text-align: center;\" width=\"68\">1<\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"457\">Mild\/moderate (focal, most portal areas)<\/td>\n<td style=\"text-align: center;\" width=\"68\">2<\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"457\">Moderate (continuous around &lt;50% of tracts or septa)<\/td>\n<td style=\"text-align: center;\" width=\"68\">3<\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"457\">Severe (continuous around &gt;50% of tracts or septa)<\/td>\n<td style=\"text-align: center;\" width=\"68\">4<\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" valign=\"TOP\" width=\"525\"><b>(B) Confluent necrosis<\/b><\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"457\">Absent<\/td>\n<td style=\"text-align: center;\" width=\"68\">0<\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"457\">Focal confluent necrosis<\/td>\n<td style=\"text-align: center;\" width=\"68\">1<\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"457\">Zone 3 necrosis in some areas<\/td>\n<td style=\"text-align: center;\" width=\"68\">2<\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"457\">Zone 3 necrosis in most areas<\/td>\n<td style=\"text-align: center;\" width=\"68\">3<\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"457\">Zone 3 necrosis+occasional portal-central (P-C) bridging<\/td>\n<td style=\"text-align: center;\" width=\"68\">4<\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"457\">Zone 3 necrosis+multiple P-C bridging<\/td>\n<td style=\"text-align: center;\" width=\"68\">5<\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"457\">Panacinar or multiacinar necrosis<\/td>\n<td style=\"text-align: center;\" width=\"68\">6<\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" valign=\"TOP\" width=\"525\"><b>(C) Focal (spotty) lytic necrosis, apoptosis and focal inflammation<\/b><\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"457\">Absent<\/td>\n<td style=\"text-align: center;\" width=\"68\">0<\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"457\">One focus or less per times 10 objective<\/td>\n<td style=\"text-align: center;\" width=\"68\">1<\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"457\">Two to four foci per times 10 objective<\/td>\n<td style=\"text-align: center;\" width=\"68\">2<\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"457\">Five to ten foci per times 10 objective<\/td>\n<td style=\"text-align: center;\" width=\"68\">3<\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"457\">More than ten foci per times 10 objective<\/td>\n<td style=\"text-align: center;\" width=\"68\">4<\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" valign=\"TOP\" width=\"525\"><b>(D) Portal inflammation<\/b><\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"457\">Absent<\/td>\n<td style=\"text-align: center;\" width=\"68\">0<\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"457\">Mild, some or all portal areas<\/td>\n<td style=\"text-align: center;\" width=\"68\">1<\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"457\">Moderate, some or all portal areas<\/td>\n<td style=\"text-align: center;\" width=\"68\">2<\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"457\">Moderate\/marked, all portal areas<\/td>\n<td style=\"text-align: center;\" width=\"68\">3<\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"457\">Marked, all portal areas<\/td>\n<td style=\"text-align: center;\" width=\"68\">4<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><b>Scheuer classification for grading and staging of chronic hepatitis<\/b><\/p>\n<table style=\"border-collapse: collapse; width: 100%;\" border=\"1\">\n<tbody>\n<tr>\n<td colspan=\"2\" valign=\"TOP\" width=\"525\"><b>Grade\u00a0Portal\/periportal activity<\/b><\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"457\">None<\/td>\n<td style=\"text-align: center;\" width=\"68\">0<\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"457\">Portal inflammation<\/td>\n<td style=\"text-align: center;\" width=\"68\">1<\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"457\">Mild piecemeal necrosis<\/td>\n<td style=\"text-align: center;\" width=\"68\">2<\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"457\">Moderate piecemeal necrosis<\/td>\n<td style=\"text-align: center;\" width=\"68\">3<\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"457\">Severe piecemeal necrosis<\/td>\n<td style=\"text-align: center;\" width=\"68\">4<\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" valign=\"TOP\" width=\"525\"><b>Lobular activity<\/b><\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"457\">None<\/td>\n<td style=\"text-align: center;\" width=\"68\">0<\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"457\">Inflammation but no necrosis<\/td>\n<td style=\"text-align: center;\" width=\"68\">1<\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"457\">Focal necrosis or acidophil bodies<\/td>\n<td style=\"text-align: center;\" width=\"68\">2<\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"457\">Severe focal cell damage<\/td>\n<td style=\"text-align: center;\" width=\"68\">3<\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"457\">Damage includes bridging necrosis<\/td>\n<td style=\"text-align: center;\" width=\"68\">4<\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" valign=\"TOP\" width=\"525\"><b>Stage Fibrosis<\/b><\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"457\">None<\/td>\n<td style=\"text-align: center;\" width=\"68\">0<\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"457\">Enlarged, fibrotic portal tracts<\/td>\n<td style=\"text-align: center;\" width=\"68\">1<\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"457\">Periportal or portal-portal septa, but intact architecture<\/td>\n<td style=\"text-align: center;\" width=\"68\">2<\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"457\">Fibrosis with architectural distortion, but no obvious cirrhosis<\/td>\n<td style=\"text-align: center;\" width=\"68\">3<\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"457\">Probable or definite cirrhosis<\/td>\n<td style=\"text-align: center;\" width=\"68\">4<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><b>Metavir classification for staging of hepatitis C liver disease<\/b><\/p>\n<table style=\"border-collapse: collapse; width: 100%;\" border=\"1\">\n<tbody>\n<tr valign=\"TOP\">\n<td width=\"457\">No scarring<\/td>\n<td style=\"text-align: center;\" width=\"68\">0<\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"457\">Minimal scarring<\/td>\n<td style=\"text-align: center;\" width=\"68\">1<\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"457\">Scarring has occurred and extends outside the areas in the liver that contains blood vessels<\/td>\n<td style=\"text-align: center;\" width=\"68\">2<\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"457\">Bridging fibrosis is spreading and connecting to other areas that contain fibrosis<\/td>\n<td style=\"text-align: center;\" width=\"68\">3<\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"457\">Cirrhosis or advanced scarring of the liver<\/td>\n<td style=\"text-align: center;\" width=\"68\">4<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p><b>References:<\/b><\/p>\n<ol>\n<li>Christensen C, Bruden D, Livingston S, Deubner H, Homan C, Smith K, Oh E, Gretch D, Williams J, McMahon B. Diagnostic accuracy of a fibrosis serum panel (FIBROSpect II) compared with Knodell and Ishak liver biopsy scores in chronic hepatitis C patients.\u00a0J Viral Hepat. 2006 Oct;13(10):652-8.\u00a0<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/16970596\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<li>Theise ND. Liver biopsy assessment in chronic viral hepatitis: a personal, practical approach. Mod Pathol. 2007 Feb;20 Suppl 1:S3-14.\u00a0<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/17486049\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<li>Hudacko R, Theise N. Liver biopsies in chronic viral hepatitis: beyond grading and staging.\u00a0Arch Pathol Lab Med. 2011 Oct;135(10):1320-8.\u00a0<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/21970487\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<li>Ishak K1, Baptista A, Bianchi L, Callea F, De Groote J, Gudat F, Denk H, Desmet V, Korb G, MacSween RN, et al. Histological grading and staging of chronic hepatitis. J Hepatol. 1995 Jun;22(6):696-9.\u00a0<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/7560864\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<li>Borcak D, Yesilbag Z, Ozdemir YE, Demir AS, Dogdas ES, Sezen AI, Unlu EC, Senoglu S, Karaosmanoglu HK, Yasar KK. Assessing Liver Fibrosis in Chronic Hepatitis B: Liver Biopsy or Non-Invasive Fibrosis Markers? J Clin Med. 2025 Nov 18;14(22):8164. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/41303199\/\" target=\"_blank\" rel=\"noopener\">[Medline]<\/a><\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p>Created Jun 23, 2015.<br \/>\nUp-date Mar 19, 2026.<\/p>\n\n<div style=\"font-size: 0px; height: 0px; line-height: 0px; margin: 0; padding: 0; clear: both;\"><\/div>","protected":false},"excerpt":{"rendered":"<p>Sorry, this entry is only available in Espa\u00f1ol.<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"no","_lmt_disable":"no","_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[53],"tags":[146,797,145,51,50,647,796,795,524,445,794,494,798],"class_list":["post-2343","post","type-post","status-publish","format-standard","hentry","category-gastroenterology","tag-chronic","tag-cirrosis","tag-cronica","tag-disease","tag-enfermedad","tag-hepatica","tag-histologic","tag-histologico","tag-liver","tag-puntuacion","tag-scoring","tag-sistema","tag-systems"],"modified_by":"Guillermo Firman","_links":{"self":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2343","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/comments?post=2343"}],"version-history":[{"count":5,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2343\/revisions"}],"predecessor-version":[{"id":10720,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2343\/revisions\/10720"}],"wp:attachment":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/media?parent=2343"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/categories?post=2343"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/tags?post=2343"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}