{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T01:13:35Z","timestamp":1788570815703,"version":"build-2803163510"},"reference-count":42,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:00:00Z","timestamp":1788480000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:00:00Z","timestamp":1788480000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Histopathology"],"abstract":"<jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Despite its clinical importance, histological steatosis assessment remains poorly standardized and highly variable among pathologists. We examined determinants of this variability by comparing pathologist estimates with quantitative artificial intelligence (AI) based measurements.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p>\n                      Ten experienced liver pathologists from four institutions evaluated a limited set of 20 permanent H&amp;E\u2010stained whole\u2010slide images (WSIs) from metabolic dysfunction\u2010associated steatotic liver disease (MASLD) cases (10 core biopsies, 7 wedge biopsies and 3 resections) and 6 additional 500\u2009\u00d7\u2009500\u2010\u03bcm image fields from separate permanent H&amp;E\u2010stained cases selected to represent varying droplet compositions. The WSIs spanned the full spectrum of steatosis severity. Assessments used four phases: default method, steatosis proportionate area (SPA), percentage of hepatocytes containing fat (%HCF) and Banff large\u2010droplet criteria. Image fields were also assessed using no size cut\u2010off or cut\u2010offs based on hepatocyte, nuclear or 2\u20133\u00d7 nuclear size. AI models quantified SPA, %HCF and droplet size for comparison with pathologists' assessments. Pathologists differed substantially in terminology, droplet\u2010size definitions and quantification methods. Method choice (SPA vs. %HCF) was a major determinant of estimate dispersion and discrepancy from AI measurements. Visual estimates exceeded AI quantification by 1.4\u20133.6\u00d7. Pathologists' SPA estimates were increasingly higher than the corresponding AI measurements with increasing burden of droplets with area below 50\u2009\u03bcm\n                      <jats:sup>2<\/jats:sup>\n                      , whereas, in exploratory analysis, %HCF estimates remained relatively stable relative to the corresponding AI measurements. Mixed\u2010effects calibration equations were derived to relate visual and digital assessment scales.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Steatosis assessment lacks standardized terminology and measurement practices. SPA and %HCF are conceptually distinct, and their interchangeable use amplifies discrepancies, particularly in small\u2010droplet\u2010rich cases. These findings support standardized, AI\u2010compatible quantification; the exploratory conversion equations require independent validation before clinical application.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/his.70272","type":"journal-article","created":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T00:54:11Z","timestamp":1788569651000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Visual steatosis assessment: method\u2010dependent variation and systematically higher estimates compared with\n                    <scp>AI<\/scp>\n                    measurement"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-6126-1398","authenticated-orcid":false,"given":"Saadiya","family":"Nazli","sequence":"first","affiliation":[{"name":"Department of Laboratory Medicine and Pathology Mayo Clinic  Rochester Minnesota 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