Role of liver biopsy in the diagnosis of NASH

: Liver biopsy interpretation remains the gold standard for diagnosis of NASH. It also permits determination of disease severity and may provide insight into prognosis. The histopathologic criteria for NASH generally include the presence of hepatic steatosis, lobular inflammation, and hepatocyte ballooning degeneration. The system proposed by Brunt remains the best known and most frequently used method for the grading and staging of NASH. Recently a histologic scoring system (NAFLD activity score (NAS)) has been proposed that can assist in diagnosis of NAFLD and may be useful for assessing the response to therapy. In our hospital, informed consent about liver biopsy was obtained from 65(56%) of 116 consecutive NAFLD patients with elevated ALT levels: 35% (23/65) had NASH, 59% (38/65) had simple steatosis, and 6% (4/65) had normal liver histology. Sampling variability continues to be a limitation of liver biopsy in staging NASH.