The Laennec staging system for histological sub-classification of cirrhosis is useful for stratification of prognosis in patients with liver cirrhosis

Kim, Seung Up; Oh, Hyun Jung; Wanless, Ian R.; Lee, Sarah; Han, Kwang-Hyub; Park, Young Nyun

doi:10.1016/j.jhep.2012.04.029

Cited by 130 publications

(121 citation statements)

References 31 publications

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“…The Laennec sub-classification of cirrhosis [16] in three subclasses of stage 4: 4A—mild cirrhosis with thin septa and large nodules; 4B—at least two broad septa, but no very broad septa and less than half of biopsy length composed of minute nodules; 4C—very broad septum or more than half of biopsy length composed of minute nodules (micronodular cirrhosis) offers additional prognosis relevance [17,18]. Moreover, histological markers of fibrosis regression under therapy, named ‘hepatic repair complex’, can be observed, and consist of delicate and perforated fibrous septa; isolated and thick collagen fibres; delicate periportal fibrous spikes; portal tract remnants; hepatic vein remnants with prolapsed hepatocytes; hepatocytes within portal tracts or splitting septa; minute regenerative nodules; and aberrant parenchymal veins [19,20].…”

Section: Gold-standard Diagnostic Methods For Cirrhosis and Portal Hymentioning

confidence: 99%

Diagnosis of cirrhosis and portal hypertension: imaging, non-invasive markers of fibrosis and liver biopsy

Procopeţ

Berzigotti

2017

Gastroenterology Report

114

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The concept of ‘cirrhosis’ is evolving and it is now clear that compensated and decompensated cirrhosis are completely different in terms of prognosis. Furthermore, the term ‘advanced chronic liver disease (ACLD)’ better reflects the continuum of histological changes occurring in the liver, which continue to progress even after cirrhosis has developed, and might regress after removing the etiological factor causing the liver disease. In compensated ACLD, portal hypertension marks the progression to a stage with higher risk of clinical complication and requires an appropriate evaluation and treatment. Invasive tests to diagnose cirrhosis (liver biopsy) and portal hypertension (hepatic venous pressure gradient measurement and endoscopy) remain of crucial importance in several difficult clinical scenarios, but their need can be reduced by using different non-invasive tests in standard cases. Among non-invasive tests, the accepted use, major limitations and major benefits of serum markers of fibrosis, elastography and imaging methods are summarized in the present review.

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Section: Gold-standard Diagnostic Methods For Cirrhosis and Portal Hymentioning

confidence: 99%

Diagnosis of cirrhosis and portal hypertension: imaging, non-invasive markers of fibrosis and liver biopsy

Procopeţ

Berzigotti

2017

Gastroenterology Report

114

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“…12 Within the field of liver pathology, the liver pathologists known as the “Gnomes” are the longest lived: Dating back to their formation in 1968, they have long since undergone their own successful second-generation renewal. A third group of liver pathologists known as the “Laennec Society” has been meeting for over 15 years 13 ; this is a larger group, sharing some membership with both the Gnomes and the Elves. Collectively, these many groups have been highly impactful in their own fields of endeavor, both through creation of shared works and through the individual scholarship of their members.…”

Section: Discussionmentioning

confidence: 99%

Strategies for a Successful Anatomic Pathology Subspecialty Workgroup

Scheuer¹,

Alves²,

Balabaud³

et al. 2016

Academic Pathology

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From 1990 to present, 14 liver pathologists and 2 clinical hepatologists from 9 countries have met annually to hold thematic 2.5-day meetings centered on case-based discussion. The goal of these meetings has been to identify gaps in knowledge in our field and fuel scholarly effort to address these gaps. The founding principles were worldwide representation, good representation of women, compatibility of participants, commitment to stable membership and regular attendance, mutual education and friendship, and free exchange of ideas. A summary report of the 2.5-day meeting constituted an enduring document that captured the free flow of ideas discussed. These ideas were open to all participants for the pursuit of scholarship back at their home institutions. However, any idea borne out of an Elves meeting merits open invitation for other Elves to participate in, using established standards for meaningful coauthorship. Over 26 consecutive meetings (1990-2015), themes covered the breadth of liver pathology. With retirement of 2 individuals, resignation of 3, and death of 1, six new members were nominated and voted into membership. Over these same 26 years, active members published 2025 articles indexed in PubMEd Central under the topic “liver;” 3% of these articles represented collaborations between members. This international group represents a successful model in a subspecialty of anatomic pathology for open exchange of ideas, mutual education, and generation of topics worthy of scholarly investigation. We conclude that a self-selected group of subspecialty pathologists can meet successfully over 26 years, maintain a high state of engagement through each annual meeting, self-renew as a result of retirement or resignation, and provide a creative stimulus for highly productive academic careers.

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“…Morphometry of decompensated cirrhosis might improve cirrhosis prognostication[20] and should be compared to a prognostic histological score, e.g. the Laennec score,[28] several items of which were included in the present morphometric scores.…”

Section: Discussionmentioning

confidence: 99%

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

Calès

Chaigneau²,

Hunault³

et al. 2015

Journal of Pathology Informatics

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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: κ = 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 (κ), 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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The Laennec staging system for histological sub-classification of cirrhosis is useful for stratification of prognosis in patients with liver cirrhosis

Cited by 130 publications

References 31 publications

Diagnosis of cirrhosis and portal hypertension: imaging, non-invasive markers of fibrosis and liver biopsy

Diagnosis of cirrhosis and portal hypertension: imaging, non-invasive markers of fibrosis and liver biopsy

Strategies for a Successful Anatomic Pathology Subspecialty Workgroup

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

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