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Liver and intrahepatic bile ducts-nontumor


Chronic hepatitis - grading / staging

Reviewers: Komal Arora, M.D. (see Reviewers page)
Revised: 28 April 2012, last major update April 2012
Copyright: (c) 2004-2012, PathologyOutlines.com, Inc.


● Diagnosis should include etiology and grading/staging based on most severe degree of portal or lobular injury (Scheuer, J Hepatol 1991;13:372)
● Sample diagnosis: Chronic hepatitis B with mild piecemeal necrosis (grade 2) and periportal fibrosis (stage 2)

Grade: degree of inflammation, piecemeal or bridging necrosis
Grade 0: no / minimal inflammation
Grade 1: portal inflammation or lobular inflammation without necrosis
Grade 2: mild periportal inflammation and piecemeal necrosis or focal hepatocellular necrosis
Grade 3: moderate periportal inflammation and piecemeal necrosis or severe focal cell damage
Grade 4: severe periportal inflammation and piecemeal necrosis or bridging necrosis

Stage: degree of fibrosis
Stage 0: no fibrosis
Stage 1: enlarged fibrotic portal tracts
Stage 2: periportal fibrosis or portal to portal septa, without architectural distortion
Stage 3: bridging fibrosis with architectural distortion, no obvious cirrhosis
Stage 4: cirrhosis (probable or definite)


Metavir algorithm for grading (evaluation of histological activity)

Batts–Ludwig diagrams of necroinflammatory activity

Ishak modification for hepatic activity index for scoring of necroinflammatory activity in chronic hepatitis

Scheuer classification for grading and staging of chronic hepatitis


Metavir score for staging of chronic hepatitis C: fibrosis is scored as F0 (absent), F1 (portal fibrosis), F2 (portal fibrosis with few septa), F3 (septal fibrosis) and F4 (cirrhosis). In addition, necroinflammation activity (A) is graded as A0 (absent), A1 (mild), A2 (moderate) or A3 (severe)

Batts–Ludwig diagrams of progression of scarring in chronic hepatitis

Ishak classification for stage of disease with modification to a 4 point scale

Micro images

Inflammatory grades 0-3

Minimally active chronic hepatitis A1F1; dilated sinusoids (Gordon Szekely stain)

Moderately active chronic hepatitis A2F2

Severe active chronic hepatitis C A3F3

Cirrhosis A2F4, VG stain

Grade 4, stage 3

Stage 4

Additional references

Mod Pathol 2007;20 Suppl 1:S3, Hepatology 2000;31:241, Arch Med Res 2007;38:634

End of Liver and intrahepatic bile ducts-nontumor > Hepatitis > Chronic hepatitis - grading / staging

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