Portal Lymphadenopathy Association with Disease Severity in Non-Alcoholic Steatohepatitis and Advanced Fibrosis in Non-Alcoholic Fatty Liver Disease

Hila Fruchtman Brot 1 Saleh Daher 2 Mira Nasser 2 Mohamad Massarwa 2 Rani Oren 2 Orit Papo 3 Rifaat Safadi 2 Tawfik Khoury 2 Jacob Sosna 1 Namma Lev Cohain 1
1Department of Radiology, Hadassah University Hospital, Ein Kerem, Israel
2The Liver Unit, Institute of Gastroenterology and Liver Diseases Department of Medicine, Hadassah University Hospital, Ein Kerem, Israel
3Department of Pathology, Hadassah University Hospital, Ein Kerem, Israel

PURPOSE: Non-alcoholic fatty liver disease (NAFLD) has emerged as the most common cause worldwide for liver cirrhosis. Many of the patients, are found to have portal lymphadenopathy (PL), which its presence needs to be evaluated and even biopsied via endoscopic ultrasound (EUS) in certain cases. Our purpose was to evaluate a possible correlation between the radiological finding of PL and NAFLD activity score (NAS), in order to assess the possible correlation between the extent of disease and PL presence as well as to avoid un-necessary biopsies.

MATERIALS AND METHODS: This retrospective, single center study, included 75 NAFLD patients without other competing etiology for liver disease or PL. All patients were with biopsy-proven pure NAFLD who had adjacent (within one year) abdominal imaging by Computed Tomography (CT) and/or Magnetic Resonance Imaging (MRI). All pathology slides and imaging files were reviewed by a blinded senior abdominal radiologist and liver expert pathologist. PL was defined as the presence of lymph nodes in that region, measuring more than 1 cm in the short diameter. The correlation between PL and NAS was examined using exact Fisher test and Pearson Chi-Square.

RESULTS: Patients were divided into three NAS severity groups: NAS 1-2 (mild), NAS 3-4 (moderate) and NAS ≥ 5 (advanced) which included 25 (33.3%), 37 (49.3%) and 13 patients (17.3%) respectively. PL in abdominal CT/MRI was noted in 32/75 (42.7%) of the patients.

PL significantly correlated with advanced NAS (≥ 5) as 69.2% of patients with

NAS≥ 5 had PL (Likelihood ratio 10, P=0.009).

Only 9% of patients without PL had advanced NAS compared to 28% of patients with PL (P=0.003). Of patients with positive PL, only 15% had mild NAS.

CONCLUSION: PL is very commonly seen with the presence of steatosis as well as is associated with its severity. PL may be used as a radiological marker for NAFLD severity which may enhance non-invasive diagnostic accuracy.

Hila Fruchtman Brot
Hila Fruchtman Brot