A Comparative Analysis of Scheuer Scoring System and Ishak Modified Histological Activity Index in Assessing Inflammation and Fibrosis from Liver Biopsies of Patients with Chronic Hepatitis

Abstract

Introduction: Chronic hepatitis is characterized by any biochemical, serological or clinical evidence of persistent or recurring liver disease lasting over six months. Histological evaluation through liver biopsy remains essential for grading and staging of the disease. Among the established scoring systems, the Ishak modified histological activity index (HAI) and the Scheuer system are widely used; yet, comparative data on their concordance remain limited.

Objectives: To determine the utility of the Ishak modified HAI system in comparison to the Scheuer system in determining the grade and stage in liver biopsies of patients with chronic hepatitis

Methods: A total of 31 liver biopsies were included in the study. Each biopsy was independently scored using the Ishak Modified HAI and Scheuer system. Inter-system agreement was measured using Cohen’s kappa. Clinical and biochemical data, including transaminase levels, were also evaluated.

Results: There were 19 females and 12 males. Their mean age was 44.5. Cohen’s kappa indicated a slight agreement for necro-inflammatory activity i.e grading (0.08) and moderate agreement for fibrosis i.e staging (0.2). The Ishak system offered more detailed stratification, particularly in intermediate stages.

Conclusions: The study concluded that both the systems are nearly equally effective for grading and staging. The level of agreement was more in terms of staging compared to grading. Ishak graded lower than Scheuer in most of the cases, while staging was seen to be higher than the Scheuer system.