Journal of Pathology Informatics Journal of Pathology Informatics
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ORIGINAL ARTICLE
Year : 2015  |  Volume : 6  |  Issue : 1  |  Page : 20

Automated morphometry provides accurate and reproducible virtual staging of liver fibrosis in chronic hepatitis C


1 HIFIH Laboratory, Unité Propre de Recherche de l'Enseignement Supérieur 3859, Sructure Fédérative de Recherche 4208; Department of Liver Gastroenterology, LUNAM University, Angers, France
2 HIFIH Laboratory, Unité Propre de Recherche de l'Enseignement Supérieur 3859, Sructure Fédérative de Recherche 4208, LUNAM University, Angers, France
3 HIFIH Laboratory, Unité Propre de Recherche de l'Enseignement Supérieur 3859, Sructure Fédérative de Recherche 4208; Department of Cellular and Tissue Pathology, CHU Angers, LUNAM University, Angers, France
4 LARIS Laboratory, Unité Propre de Recherche de l'Enseignement Supérieur 7315, LUNAM University, Angers, France

Correspondence Address:
Marie-Christine Rousselet
HIFIH Laboratory, Unité Propre de Recherche de l'Enseignement Supérieur 3859, Sructure Fédérative de Recherche 4208; Department of Cellular and Tissue Pathology, CHU Angers, LUNAM University, Angers
France
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2153-3539.157782

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Background: Liver fibrosis staging provides prognostic value, although hampered by observer variability. We used digital analysis to develop diagnostic morphometric scores for significant fibrosis, cirrhosis and fibrosis staging in chronic hepatitis C. Materials and Methods: We automated the measurement of 44 classical and new morphometric descriptors. The reference was histological METAVIR fibrosis (F) staging (F0 to F4) on liver biopsies. The derivation population included 416 patients and liver biopsies ≥20 mm-length. Two validation population included 438 patients. Results: In the derivation population, the area under the receiver operating characteristic (AUROC) for clinically significant fibrosis (F stage ≥2) of a logistic score combining 5 new descriptors (stellar fibrosis area, edge linearity, bridge thickness, bridge number, nodularity) was 0.957. The AUROC for cirrhosis of 6 new descriptors (edge linearity, nodularity, portal stellar fibrosis area, portal distance, granularity, fragmentation) was 0.994. Predicted METAVIR F staging combining 8 morphometric descriptors agreed well with METAVIR F staging by pathologists: k = 0.868. Morphometric score of clinically significant fibrosis had a higher correlation with porto-septal fibrosis area (rs = 0.835) than METAVIR F staging (rs = 0.756, P < 0.001) and the same correlations with fibrosis biomarkers, e.g., serum hyaluronate: rs = 0.484 versus rs = 0.476 for METAVIR F (P = 0.862). In the validation population, the AUROCs of clinically significant fibrosis and cirrhosis scores were, respectively: 0.893 and 0.993 in 153 patients (biopsy < 20 mm); 0.955 and 0.994 in 285 patients (biopsy ≥ 20 mm). The three morphometric diagnoses agreed with consensus expert reference as well as or better than diagnoses by first-line pathologists in 285 patients, respectively: significant fibrosis: 0.733 versus 0.733 (k), cirrhosis: 0.900 versus 0.827, METAVIR F: 0.881 versus 0.865. Conclusion: The new automated morphometric scores provide reproducible and accurate diagnoses of fibrosis stages via "virtual expert pathologist."


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