Pada interpretasi hasil biopsi dari hati , penilaian terhadap grading dan staging dapat dilakukan dengan berbagai sistem, antara lain : Metavir scoring
system, Knodell score atau HAI Histologic Activity Index yang kemudian dimodifikasi oleh Kamal Ishak, Scheuer scheme , Batt scheme . Dalam
melakukan diagnosa, penilaian grading dan staging ini dapat menggunakan salah satu system tersebut diatas, namun sebaiknya dapat diambil kesepakatan
mengenai system yang akan digunakan.
2.6.1. Metavir Scoring System
15,20,23
Grading Activity A1, A2, A3, A4
Piecemeal necrosis Lobuar necrosis
portal inflammation Bridging necrosis
Staging
Fibrosis, F1, F2, F3, F4
Universitas Sumatera Utara
Tabel 4. Metavir Histologic Activity Score
20
Activity score A Piecemeal necrosis
Lobular necrosis PMN
LN ---------------------------------------------------------------------------------------
A=0 PMN=0
LN=0 A=1
PMN=0 LN=1
PMN=1 LN=0,1
A=2 PMN=0
LN=2 PMN=1
LN=2 PMN=2
LN=0,1 A=3
PMN=2 or PMN=3 LN=2
LN=0,1,
Tabel 5. Metavir Histologic Activity Criteria
20
Histologic feature Score
Criteria
No
Piecemeal necrosis
1 Mild - focal alteration of the
periportal plate in some portal tracts 2
Moderate - diffuse alteration of thr periportal plate in some tracts or
focal lesions around all portal tracts 3
Severe - diffuse alteration of the periportal plate in all portal tracts.
Universitas Sumatera Utara
Lobular necrosis No or mild - less than one
necro inflammatory focus per lobule 1 Moderate- at least one necroinflammatory
focus per lobule 2 Severe - several necro inflammatory foci
per lobule, or confluent or bridging necrosis
Portal inflammation No
1 Mild - presence of mononuclear aggregates in
some portal tracts 2
Moderate - mononuclear aggregates in all portal tracts
3 Severe - large and dense mononuclear
aggregates in all portal tracts
Bridging necrosis YES Necroinflammatory foci linking 2 portal tracts or
a portal tract with a terminal hepatic venul NO
Tabel 6. Metavir Fibrosis Score
20
Score Criteria
F0 Portal inflammation
F1 Portal fibrosis without septa
F2 Portal fibrosis with rare septa
F3 Numerous septa without cirrhosis
F4 Cirrhosis
Universitas Sumatera Utara
Gambar 11. Algorithm for the evaluation of histological activity: PMN, piecemeal necrosis; 0, none; 1, mild; 2, moderate; 3, severe; LN, lobular necrosis; 0, none or mild; 1, moderate; 2,
severe; A, histological activity; 0, none; 1, mild; 2, moderate; 3, severe.
20
Gambar 12. Scoring metavir pada fibrosis hati
15
Universitas Sumatera Utara
2.7. Penulisan Diagnosis Pada Pemeriksaan Mikroskopis Biopsi Hati
