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Dae Young Kang 3 Articles
A scoring system for the diagnosis of non-alcoholic steatohepatitis from liver biopsy
Kyoungbun Lee, Eun Sun Jung, Eunsil Yu, Yun Kyung Kang, Mee-Yon Cho, Joon Mee Kim, Woo Sung Moon, Jin Sook Jeong, Cheol Keun Park, Jae-Bok Park, Dae Young Kang, Jin Hee Sohn, So-Young Jin
J Pathol Transl Med. 2020;54(3):228-236.   Published online April 15, 2020
  • 4,058 View
  • 176 Download
  • 2 Citations
AbstractAbstract PDF
Liver biopsy is the essential method to diagnose non-alcoholic steatohepatitis (NASH), but histological features of NASH are too subjective to achieve reproducible diagnoses in early stages of disease. We aimed to identify the key histological features of NASH and devise a scoring model for diagnosis.
Thirteen pathologists blindly assessed 12 histological factors and final histological diagnoses (‘not-NASH,’ ‘borderline,’ and ‘NASH’) of 31 liver biopsies that were diagnosed as non-alcoholic fatty liver disease (NAFLD) or NASH before and after consensus. The main histological parameters to diagnose NASH were selected based on histological diagnoses and the diagnostic accuracy and agreement of 12 scoring models were compared for final diagnosis and the NAFLD Activity Score (NAS) system.
Inter-observer agreement of final diagnosis was fair (κ = 0.25) before consensus and slightly improved after consensus (κ = 0.33). Steatosis at more than 5% was the essential parameter for diagnosis. Major diagnostic factors for diagnosis were fibrosis except 1C grade and presence of ballooned cells. Minor diagnostic factors were lobular inflammation ( ≥ 2 foci/ × 200 field), microgranuloma, and glycogenated nuclei. All 12 models showed higher inter-observer agreement rates than NAS and post-consensus diagnosis (κ = 0.52–0.69 vs. 0.33). Considering the reproducibility of factors and practicability of the model, summation of the scores of major (× 2) and minor factors may be used for the practical diagnosis of NASH.
A scoring system for the diagnosis of NAFLD would be helpful as guidelines for pathologists and clinicians by improving the reproducibility of histological diagnosis of NAFLD.


Citations to this article as recorded by  
  • Changes in indications for outpatient percutaneous liver biopsy over 5 years: from hepatitis C to fatty liver disease
    Marlone Cunha-Silva, Luíza D. Torres, Mariana F. Fernandes, Tirzah de M. Lopes Secundo, Marina C.G. Moreira, Ademar Yamanaka, Leonardo T. Monici, Larissa B. Eloy da Costa, Daniel F. Mazo, Tiago Sevá-Pereira
    Gastroenterología y Hepatología.2022; 45(8): 579.     CrossRef
  • Changes in indications for outpatient percutaneous liver biopsy over 5 years: from hepatitis C to fatty liver disease
    Marlone Cunha-Silva, Luíza D. Torres, Mariana F. Fernandes, Tirzah de M. Lopes Secundo, Marina C.G. Moreira, Ademar Yamanaka, Leonardo T. Monici, Larissa B. Eloy da Costa, Daniel F. Mazo, Tiago Sevá-Pereira
    Gastroenterología y Hepatología (English Edition).2022; 45(8): 579.     CrossRef
Interobserver Agreement on Pathologic Features of Liver Biopsy Tissue in Patients with Nonalcoholic Fatty Liver Disease
Eun Sun Jung, Kyoungbun Lee, Eunsil Yu, Yun Kyung Kang, Mee-Yon Cho, Joon Mee Kim, Woo Sung Moon, Jin Sook Jeong, Cheol Keun Park, Jae-Bok Park, Dae Young Kang, Jin Hee Sohn, So-Young Jin
J Pathol Transl Med. 2016;50(3):190-196.   Published online April 18, 2016
  • 9,331 View
  • 217 Download
  • 19 Citations
AbstractAbstract PDF
The histomorphologic criteria for the pathological features of liver tissue from patients with non-alcoholic fatty liver disease (NAFLD) remain subjective, causing confusion among pathologists and clinicians. In this report, we studied interobserver agreement of NAFLD pathologic features and analyzed causes of disagreement.
Thirty-one cases of clinicopathologically diagnosed NAFLD from 10 hospitals were selected. One hematoxylin and eosin and one Masson’s trichrome-stained virtual slide from each case were blindly reviewed with regard to 12 histological parameters by 13 pathologists in a gastrointestinal study group of the Korean Society of Pathologists. After the first review, we analyzed the causes of disagreement and defined detailed morphological criteria. The glass slides from each case were reviewed a second time after a consensus meeting. The degree of interobserver agreement was determined by multi-rater kappa statistics.
Kappa values of the first review ranged from 0.0091–0.7618. Acidophilic bodies (k = 0.7618) and portal inflammation (k = 0.5914) showed high levels of agreement, whereas microgranuloma (k = 0.0984) and microvesicular fatty change (k = 0.0091) showed low levels of agreement. After the second review, the kappa values of the four major pathological features increased from 0.3830 to 0.5638 for steatosis grade, from 0.1398 to 0.2815 for lobular inflammation, from 0.1923 to 0.3362 for ballooning degeneration, and from 0.3303 to 0.4664 for fibrosis.
More detailed histomorphological criteria must be defined for correct diagnosis and high interobserver agreement of NAFLD.


Citations to this article as recorded by  
  • Non-alcoholic fatty liver disease: the pathologist’s perspective
    Wei-Qiang Leow, Anthony Wing-Hung Chan, Paulo Giovanni L. Mendoza, Regina Lo, Kihan Yap, Haeryoung Kim
    Clinical and Molecular Hepatology.2023; 29(Suppl): S302.     CrossRef
  • CT-based Hounsfield unit values reflect the degree of steatohepatitis in patients with low-grade fatty liver disease
    Ha Neul Kim, Hong Jae Jeon, Hei Gwon Choi, In Sun Kwon, Woo Sun Rou, Jeong Eun Lee, Tae Hee Lee, Seok Hyun Kim, Byung Seok Lee, Kyung Sook Shin, Hyun Jung Lee, Hyuk Soo Eun
    BMC Gastroenterology.2023;[Epub]     CrossRef
  • Improved pathology reporting in NAFLD/NASH for clinical trials
    Caitlin Rose Langford, Marc H Goldinger, Darren Treanor, Clare McGenity, Jonathan R Dillman, Daniela S Allende, Robert Goldin, Elizabeth M Brunt, Kurt Zatloukal, Helmut Denk, Kenneth A Fleming
    Journal of Clinical Pathology.2022; 75(2): 73.     CrossRef
  • Standardizing the histological assessment of late posttransplantation biopsies from pediatric liver allograft recipients
    Stefan G. Hübscher, Sandy Feng, Annette S. H. Gouw, Hironori Haga, Hyo Jeong Kang, Deirdre A. Kelly, Mina Komuta, Andrew Lesniak, Benjamin A. Popp, Henkjan J. Verkade, Eunsil Yu, Anthony J. Demetris
    Liver Transplantation.2022; 28(9): 1475.     CrossRef
  • Discordant pathological diagnosis of non‐alcoholic fatty liver disease: A prospective multicenter study
    Takuya Kuwashiro, Hirokazu Takahashi, Hideyuki Hyogo, Yuji Ogawa, Kento Imajo, Masato Yoneda, Takashi Nakahara, Satoshi Oeda, Kenichi Tanaka, Yuichiro Amano, Shinji Ogawa, Atsushi Kawaguchi, Shinichi Aishima, Masayoshi Kage, Kazuaki Chayama, Atsushi Nakaj
    JGH Open.2020; 4(3): 497.     CrossRef
  • Obeticholic acid for the treatment of nonalcoholic steatohepatitis: Expectations and concerns
    Stergios A. Polyzos, Jannis Kountouras, Christos S. Mantzoros
    Metabolism.2020; 104: 154144.     CrossRef
  • A scoring system for the diagnosis of non-alcoholic steatohepatitis from liver biopsy
    Kyoungbun Lee, Eun Sun Jung, Eunsil Yu, Yun Kyung Kang, Mee-Yon Cho, Joon Mee Kim, Woo Sung Moon, Jin Sook Jeong, Cheol Keun Park, Jae-Bok Park, Dae Young Kang, Jin Hee Sohn, So-Young Jin
    Journal of Pathology and Translational Medicine.2020; 54(3): 228.     CrossRef
  • An Improved qFibrosis Algorithm for Precise Screening and Enrollment into Non-Alcoholic Steatohepatitis (NASH) Clinical Trials
    Wei-Qiang Leow, Pierre Bedossa, Feng Liu, Lai Wei, Kiat-Hon Lim, Wei-Keat Wan, Yayun Ren, Jason Pik-Eu Chang, Chee-Kiat Tan, Aileen Wee, George Boon-Bee Goh
    Diagnostics.2020; 10(9): 643.     CrossRef
  • Deep learning quantification of percent steatosis in donor liver biopsy frozen sections
    Lulu Sun, Jon N. Marsh, Matthew K. Matlock, Ling Chen, Joseph P. Gaut, Elizabeth M. Brunt, S. Joshua Swamidass, Ta-Chiang Liu
    EBioMedicine.2020; 60: 103029.     CrossRef
  • Magnetic resonance elastography SE-EPI vs GRE sequences at 3T in a pediatric population with liver disease
    Juan S. Calle-Toro, Suraj D. Serai, Erum A. Hartung, David J. Goldberg, Bradley D. Bolster, Kassa Darge, Sudha A. Anupindi
    Abdominal Radiology.2019; 44(3): 894.     CrossRef
  • R2 relaxometry based MR imaging for estimation of liver iron content: A comparison between two methods
    Juan S. Calle-Toro, Christian A. Barrera, Dmitry Khrichenko, Hansel J. Otero, Suraj D. Serai
    Abdominal Radiology.2019; 44(9): 3058.     CrossRef
  • Inhibition of mitochondrial fatty acid oxidation in drug-induced hepatic steatosis
    Bernard Fromenty
    Liver Research.2019; 3(3-4): 157.     CrossRef
  • Standardising the interpretation of liver biopsies in non-alcoholic fatty liver disease clinical trials
    Rish K. Pai, David E. Kleiner, John Hart, Oyedele A. Adeyi, Andrew D. Clouston, Cynthia A. Behling, Dhanpat Jain, Sanjay Kakar, Mayur Brahmania, Lawrence Burgart, Kenneth P. Batts, Mark A. Valasek, Michael S. Torbenson, Maha Guindi, Hanlin L. Wang, Veeral
    Alimentary Pharmacology & Therapeutics.2019; 50(10): 1100.     CrossRef
  • NAFLD Histology: a Critical Review and Comparison of Scoring Systems
    Rish K. Pai
    Current Hepatology Reports.2019; 18(4): 473.     CrossRef
  • Hepatic sonic hedgehog protein expression measured by computer assisted morphometry significantly correlates with features of non-alcoholic steatohepatitis
    Michael Estep, Rohini Mehta, Gary Bratthauer, Lakshmi Alaparthi, Fanny Monge, Simon Ali, Dinan Abdelatif, Zahra Younoszai, Maria Stepanova, Zachary D. Goodman, Zobair M. Younossi
    BMC Gastroenterology.2019;[Epub]     CrossRef
  • Validation of intimate correlation between visceral fat and hepatic steatosis: Quantitative measurement techniques using CT for area of fat and MR for hepatic steatosis
    Moon Hyung Choi, Joon-Il Choi, Michael Yong Park, Sung Eun Rha, Soon Nam Oh, Seung Eun Jung, Jae Young Byun, Stephan Kannengiesser, Yohan Son
    Clinical Nutrition.2018; 37(1): 214.     CrossRef
  • Ultrasound or MR elastography of liver: which one shall I use?
    Meng Yin, Sudhakar K. Venkatesh
    Abdominal Radiology.2018; 43(7): 1546.     CrossRef
  • Feasibility and agreement of stiffness measurements using gradient-echo and spin-echo MR elastography sequences in unselected patients undergoing liver MRI
    Guilherme Moura Cunha, Kevin J Glaser, Anke Bergman, Rodrigo P Luz, Eduardo H de Figueiredo, Flavia Paiva Proença Lobo Lopes
    The British Journal of Radiology.2018; : 20180126.     CrossRef
  • Second harmonic generation microscopy provides accurate automated staging of liver fibrosis in patients with non-alcoholic fatty liver disease
    Pik Eu Chang, George Boon Bee Goh, Wei Qiang Leow, Liang Shen, Kiat Hon Lim, Chee Kiat Tan, Manlio Vinciguerra
    PLOS ONE.2018; 13(6): e0199166.     CrossRef
Proposal for a Standardized Pathology Report of Gastroenteropancreatic Neuroendocrine Tumors: Prognostic Significance of Pathological Parameters
Mee-Yon Cho, Jin Hee Sohn, So Young Jin, Hyunki Kim, Eun Sun Jung, Mi-Jung Kim, Kyoung-Mee Kim, Woo Ho Kim, Joon Mee Kim, Yun Kyung Kang, Joon Hyuk Choi, Dae Young Kang, Youn Wha Kim, Eun Hee Choi
Korean J Pathol. 2013;47(3):227-237.   Published online June 25, 2013
  • 12,396 View
  • 136 Download
  • 12 Citations
AbstractAbstract PDF

There is confusion in the diagnosis and biological behaviors of gastroenteropancreatic neuroendocrine tumors (GEP-NETs), because of independently proposed nomenclatures and classifications. A standardized form of pathology report is required for the proper management of patients.


We discussed the proper pathological evaluation of GEP-NET at the consensus conference of the subcommittee meeting for the Gastrointestinal Pathology Study Group of the Korean Society of Pathologists. We then verified the prognostic significance of pathological parameters from our previous nationwide collection of pathological data from 28 hospitals in Korea to determine the essential data set for a pathology report.


Histological classification, grading (mitosis and/or Ki-67 labeling index), T staging (extent, size), lymph node metastasis, and lymphovascular and perineural invasion were significant prognostic factors and essential for the pathology report of GEP-NET, while immunostaining such as synaptophysin and chromogranin may be optional. Furthermore, the staging system, either that of the 2010 American Joint Cancer Committee (AJCC) or the European Neuroendocrine Tumor Society (ENETS), should be specified, especially for pancreatic neuroendocrine neoplasms.


A standardized pathology report is crucial for the proper management and prediction of prognosis of patients with GEP-NET.


Citations to this article as recorded by  
  • Analysis of Prognostic Risk Factors of Endoscopic Submucosal Dissection (ESD) and Curative Resection of Gastrointestinal Neuroendocrine Neoplasms
    Yuan Si, ChaoKang Huang, JingBin Yuan, XianHui Zhang, QingQiang He, ZhiJin Lin, Ling He, ZhongXin Liu, Yuvaraja Teekaraman
    Contrast Media & Molecular Imaging.2022; 2022: 1.     CrossRef
  • Standardization of the pathologic diagnosis of appendiceal mucinous neoplasms
    Dong-Wook Kang, Baek-hui Kim, Joon Mee Kim, Jihun Kim, Hee Jin Chang, Mee Soo Chang, Jin-Hee Sohn, Mee-Yon Cho, So-Young Jin, Hee Kyung Chang, Hye Seung Han, Jung Yeon Kim, Hee Sung Kim, Do Youn Park, Ha Young Park, So Jeong Lee, Wonae Lee, Hye Seung Lee,
    Journal of Pathology and Translational Medicine.2021; 55(4): 247.     CrossRef
  • Preoperative diagnosis of well‐differentiated neuroendocrine tumor in common hepatic duct by brush cytology: A case report
    Jiwoon Choi, Kyong Joo Lee, Sung Hoon Kim, Mee‐Yon Cho
    Diagnostic Cytopathology.2019;[Epub]     CrossRef
  • Primary renal well-differentiated neuroendocrine tumors: report of six cases with an emphasis on the Ki-67 index and mitosis
    Bohyun Kim, Han-Seong Kim, Kyung Chul Moon
    Diagnostic Pathology.2019;[Epub]     CrossRef
  • Primary low-grade neuroendocrine carcinoma of the skin: An exceedingly rare entity
    Tiffany Y. Chen, Annie O. Morrison, Joe Susa, Clay J. Cockerell
    Journal of Cutaneous Pathology.2017; 44(11): 978.     CrossRef
  • Prognostic Validity of the American Joint Committee on Cancer and the European Neuroendocrine Tumors Staging Classifications for Pancreatic Neuroendocrine Tumors
    Jae Hee Cho, Ji Kon Ryu, Si Young Song, Jin-Hyeok Hwang, Dong Ki Lee, Sang Myung Woo, Young-Eun Joo, Seok Jeong, Seung-Ok Lee, Byung Kyu Park, Young Koog Cheon, Jimin Han, Tae Nyeun Kim, Jun Kyu Lee, Sung-Hoon Moon, Hyunjin Kim, Eun Taek Park, Jae Chul Hw
    Pancreas.2016; 45(7): 941.     CrossRef
  • Early diagnosis and treatment of gastrointestinal neuroendocrine tumors
    Hong Shen, Zhuo Yu, Jing Zhao, Xiu-Zhen Li, Wen-Sheng Pan
    Oncology Letters.2016; 12(5): 3385.     CrossRef
  • Recent Updates on Neuroendocrine Tumors From the Gastrointestinal and Pancreatobiliary Tracts
    Joo Young Kim, Seung-Mo Hong
    Archives of Pathology & Laboratory Medicine.2016; 140(5): 437.     CrossRef
  • Pancreatic neuroendocrine tumors: Correlation between the contrast-enhanced computed tomography features and the pathological tumor grade
    Koji Takumi, Yoshihiko Fukukura, Michiyo Higashi, Junnichi Ideue, Tomokazu Umanodan, Hiroto Hakamada, Ichiro Kanetsuki, Takashi Yoshiura
    European Journal of Radiology.2015; 84(8): 1436.     CrossRef
  • Tumeurs neuroendocrines du tube digestif et du pancréas : ce que le pathologiste doit savoir et doit faire en 2014
    Jean-Yves Scoazec, Anne Couvelard
    Annales de Pathologie.2014; 34(1): 40.     CrossRef
  • Spectrum of Gastroenteropancreatic NENs in Routine Histological Examinations of Bioptic and Surgical Specimen: A Study of 161 Cases Collected from 17 Departments of Pathology in the Czech Republic
    Václav Mandys, Tomáš Jirásek
    Gastroenterology Research and Practice.2014; 2014: 1.     CrossRef
  • p27 Loss Is Associated with Poor Prognosis in Gastroenteropancreatic Neuroendocrine Tumors
    Hee Sung Kim, Hye Seung Lee, Kyung Han Nam, Jiwoon Choi, Woo Ho Kim
    Cancer Research and Treatment.2014; 46(4): 383.     CrossRef

JPTM : Journal of Pathology and Translational Medicine