LAPAROSCOPIC FEATURES AND INTEROBSERVER VARIATION OF HISTOLOGICAL DIAGNOSIS IN PATIENTS WITH NON‐ALCOHOLIC FATTY LIVER DISEASE

Background: There is a lack of information regarding the laparoscopic features and interobserver variation of histological diagnosis in patients with non‐alcoholic fatty liver disease (NAFLD). Methods: Thirty‐five patients with NAFLD were studied for laparoscopic and histological findings. For the study of interobserver variation of histological diagnosis, two pathologists from different hospitals independently observed the 35 liver samples with patient names blinded to the pathologists. Assessment of laparoscopic findings on the diagnosis of non‐alcoholic steatohepatitis (NASH) was also investigated. Results: Histological diagnoses of the two pathologists were identical in 28 (five fatty liver, 23 NASH) patients, whereas they were not identical in seven patients (20%). The difference of diagnosis was mainly caused by the difference of judgment of minimal fibrosis and minimal necroinflammatory grade. Analysis of the laparoscopic findings revealed that small regular depressions were frequently found on the liver surface in patients with NASH. Scatter of dye on the liver surface facilitated the observation of this finding. Sensitivity and specificity of small depressions in the diagnosis of NASH was 73.9% and 80.0%, respectively. Conclusion: Interobserver variation of the diagnosis was found in 20% of patients with NAFLD. Small regular depressions were characteristic findings of NASH. Laparoscopy is assessed to be useful for diagnosis of NAFLD, especially of early stage of NASH.