Pathology Associates Of Lexington, P.A.

Methotrexate, grading liver biopsies

Grading Liver Biopsies
For
Methotrexate Therapy Effect

The Subcommittee on Methotrexate of the Psoriasis Task Force of the National Program for Dermatology prepared and published guidelines concerning methotrexate therapy for psoriasis in 1971 (Arch Dermatol 105:363, 1972). On the basis of a review of over 1000 liver biopsy specimens from psoriatic patients receiving methotrexate therapy, initial liver biopsy grading criteria were put together within a "guidelines" in 1972. Updates were published in 1982 and 1988, the last being noted below (J Am Acad Dermatol 19(1):145-156, 1988):

Liver Biopsy Grading

Grade I:

Normal; fatty infiltration, mild; nuclear variability, mild; portal inflammation, mild

Grade II:

Fatty infiltration, moderate [L06-10340] to severe; nuclear variability,

moderate to severe; portal tract expansion, portal tract inflammation,

and necrosis, moderate to severe.

Grade III:

A, Fibrosis, mild (Portal fibrosis here denotes formation of fibrotic septa extending into the lobules. Slight enlargement of portal tracts without disruption of limiting plates or septum formation does not put the biopsy specimen in grade III.)

B, Fibrosis, moderate to severe.

Grade IV:

Cirrhosis (Regenerating nodules as well as bridging of portal tracts must

be demonstrated.)

Clinical Implications of the Grade

a. Patients with Grade I or II changes may continue to receive

methotrexate therapy.

b. Patients with Grade III-A changes may continue to receive methotrexate therapy but should have a repeat liver biopsy after approximately 6 months of continued methotrexate therapy.

c. Patients with Grades III-B and IV should not be given further methotrexate therapy. Exceptional circumstances, however, may require continued methotrexate therapy, with careful follow-up liver biopsies.