Liver Biopsy Scoring Systems

Ishak Score: Total = Necroinflammatory + Stage

Ishak Stage – Architecture

  • 0 No fibrosis
  • 1 Fibrosis in some portal areas
  • 2 Fibrosis in most portal areas
  • 3 Occasional P-P bridging
  • 4 P-P & P-C bridging
  • 5 Bridging & occasional nodules
  • 6 Cirrhosis

Necroinflammatory

Interface hepatitis

  • 0 None
  • 1 Focal, few portal areas
  • 2 Focal, most portal areas
  • 3 Around <50% tracts or septa
  • 4 Around >50% tracts or septa

Confluent Necrosis

  • 0 None
  • 1 Focal
  • 2 Zone 3 in some areas
  • 3 Zone 3 in most areas
  • 4 Zone 3 & occasional C bridging
  • 5 Zone 3 & multiple P-C bridging
  • 6 Panacinar

Focal Necrosis, Apoptosis, Inflammation

  • 0 None
  • 2 2-4 foci per 10x
  • 3 5-10 foci per 10x
  • 4 >10 foci per 10

Portal inflammation

  • 0 None
  • 1 Mild
  • 2 Moderate
  • 3 Moderate & all portal areas
  • 4 Marked and all portal areas

Steatosis Score

  • 0 Absent
  • 1 Mild
  • 2 Moderate
  • 3 Severe

Siderosis

  • 0 Absent or barely discernable @ x 400
  • 1 Barely discernable @x250, confirmed @x400
  • 2 Resolved @x100
  • 3 Resolved @x25
  • 4 Resolved @x10
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