Our Summary

Non-alcoholic steatohepatitis (NASH) is a liver disease that is becoming increasingly common worldwide. Currently, there are no approved treatments for it. One of the challenges in developing drugs for NASH is the need for detailed analysis of liver tissue samples, a process that can be inconsistent and complex.

As such, there is a pressing need for more precise, reliable, and automated methods to assist with this analysis and improve the development and evaluation of potential treatments. One promising approach involves the use of digital pathology (DP) and artificial intelligence (AI). These tools have already proven useful in other areas of medicine, and they are now being explored for use in NASH.

DP and AI can automatically detect and measure certain features in tissue samples, which could help reduce inconsistencies in clinical trials for NASH drugs. This article reviews these tools and their potential applications in NASH, as well as some of the regulatory considerations involved.

Overall, the use of DP and AI in NASH is a high priority, particularly as it could greatly aid in the development of effective treatments for the disease.

FAQs

  1. What challenges are currently faced in developing drugs for non-alcoholic steatohepatitis (NASH)?
  2. How can digital pathology (DP) and artificial intelligence (AI) assist in the development and evaluation of treatments for NASH?
  3. What potential applications do DP and AI have in non-alcoholic steatohepatitis (NASH)?

Doctor’s Tip

A doctor might tell a patient undergoing a liver biopsy that it is a procedure used to obtain a small sample of liver tissue for analysis. The doctor may explain that the biopsy can help diagnose liver conditions such as NASH and determine the extent of liver damage. The doctor may also inform the patient about the potential risks of the procedure, such as bleeding or infection, and provide instructions on how to prepare for the biopsy and what to expect during and after the procedure. Additionally, the doctor may discuss the importance of following post-biopsy care instructions to ensure proper healing and minimize complications.

Suitable For

Patients who are typically recommended for a liver biopsy include those with:

  1. Chronic liver diseases such as hepatitis B or C, alcoholic liver disease, autoimmune liver diseases, and genetic liver diseases.
  2. Non-alcoholic fatty liver disease (NAFLD), especially if there is suspicion of advanced liver fibrosis or cirrhosis.
  3. Abnormal liver function tests that cannot be explained by other tests or imaging studies.
  4. Monitoring of liver disease progression or response to treatment.
  5. Evaluation of liver tumors or masses.
  6. Suspected liver infections or inflammation.
  7. Evaluation of unexplained liver enlargement or abnormal liver imaging findings.

It is important to note that a liver biopsy is an invasive procedure and should be carefully considered by a healthcare provider based on the individual patient’s condition and medical history.

Timeline

Before a liver biopsy:

  1. Patient consultation and discussion of symptoms and medical history
  2. Blood tests to check liver function and clotting ability
  3. Imaging tests such as ultrasound or CT scan to locate the best area for biopsy
  4. Patient fasting before the procedure
  5. Consent form signed by the patient

During and after a liver biopsy:

  1. Local anesthesia is administered to numb the area
  2. Needle is inserted into the liver to collect a tissue sample
  3. Patient may feel pressure or discomfort during the procedure
  4. Tissue sample is sent to the lab for analysis
  5. Patient is monitored for a few hours post-procedure for any complications
  6. Results of the biopsy are typically available within a week
  7. Follow-up appointment with the doctor to discuss the results and next steps in treatment.

What to Ask Your Doctor

Some questions a patient should ask their doctor about liver biopsy include:

  1. Why do I need a liver biopsy?
  2. What can I expect during the procedure?
  3. Are there any risks or complications associated with a liver biopsy?
  4. How will the results of the biopsy impact my treatment plan?
  5. How long will it take to receive the biopsy results?
  6. Are there any restrictions or precautions I need to follow after the procedure?
  7. Will I need to undergo any additional tests or procedures based on the biopsy results?
  8. Are there any alternative diagnostic tests or imaging techniques that could be considered instead of a liver biopsy?
  9. What experience do you have performing liver biopsies, and what is the success rate of the procedure?
  10. Can you explain the potential benefits of using digital pathology and artificial intelligence in analyzing my liver biopsy samples for NASH?

Reference

Authors: Ratziu V, Hompesch M, Petitjean M, Serdjebi C, Iyer JS, Parwani AV, Tai D, Bugianesi E, Cusi K, Friedman SL, Lawitz E, Romero-Gómez M, Schuppan D, Loomba R, Paradis V, Behling C, Sanyal AJ. Journal: J Hepatol. 2024 Feb;80(2):335-351. doi: 10.1016/j.jhep.2023.10.015. Epub 2023 Oct 24. PMID: 37879461