Hepatitis C, The Knodell Histology Activity Index | Hepatitis Central

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The Knodell Histology Activity Index

table  1.    HAI for Numerical Scoring of Liver Biopsy Specimens
I. Periportal +/ -
Bridging Necrosis		 Score II. Intralobular
Degeneration * and
Focal Necrosis		 Score III. Portal
Inflammation		 Score IV. Fibrosis Score
A. None 0 A. None 0 A.  No portal inflammation 0 A. No fibrosis 0
B.  Mild piecemeal necrosis 1 B.  Mild (acidophilic bodies, ballooning degeneration and/or scattered foci of hepatocellular necrosis in <1/3 of lobules or nodulles) 1 B.  Mild (sprinkling of inflammatory cells in <1/3 of portal tracts) 1 B.  Fibrous portal expansion 1
C.  Moderate piecemeal necrosis (involves less than 50% of the circumference of most portal tracts) 3 C.  Moderate (involvement of 1/3-2/3 of lobules or nodules) 3 C.  Moderate (increased inflammatory cells in 1/3-2/3 of portal tracts) 3 C.  Bridging fibrosis (portal-portal or portal-central linkage) 3
D.  Marked piecemeal necrosis (involves more than 50% of the circumference of most portal tracts) 4 D.  Marked (involvement of >2/3 of lobules or nodules) 4 D.  Marked (dense packing of inflammatory cells in >2/3 of portal tracts) 4 D. Cirrhosis dagger 4
E.  Moderate piecemeal necrosis plus bridging necrosis Dagger 5
F.  Marked piecemeal necrosis plus bridging necrosis Dagger 6
G.  Multilobular necrosis § 10
NOTE. HAI score is the combined scores for necrosis, inflammation, and fibrosis.
* Degeneration --- acidophil bodies, ballooning; focal necrosis-scattered foci of hepatocellular necrosis.
dagger Loss of normal hepatic lobular architecture with fibrous septae separating and surrounding nodules.
Dagger Bridging is defined as >= 2 bridges in the liver biopsy specimen; no distinction is made between portal-portal and portal-central linkage.
§ Two or more contiguous lobules with panlobular necrosis.
Modified and reprinted with permission. 1

Reference: Knodell RG, et al.


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