{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T07:35:10Z","timestamp":1788593710764,"version":"build-2803163510"},"reference-count":39,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2020,8,28]],"date-time":"2020-08-28T00:00:00Z","timestamp":1598572800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Key R&amp;D Program of China (2016YFE0116800) and grants from the China National Science and Technology Major Project for Infectious Diseases Control during the 13th Five-Year Plan Period (2018ZX09201002-001-005) and National Natural Science Foundati","award":["2016YFE0116800, 2018ZX09201002-001-005, 81870407"],"award-info":[{"award-number":["2016YFE0116800, 2018ZX09201002-001-005, 81870407"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Many clinical trials with potential drug treatment options for non-alcoholic fatty liver disease (NAFLD) are focused on patients with non-alcoholic steatohepatitis (NASH) stages 2 and 3 fibrosis. As the histological features differentiating stage 1 (F1) from stage 2 (F2) NASH fibrosis are subtle, some patients may be wrongly staged by the in-house pathologist and miss the opportunity for enrollment into clinical trials. We hypothesized that our refined artificial intelligence (AI)-based algorithm (qFibrosis) can identify these subtle differences and serve as an assistive tool for in-house pathologists. Methods: Liver tissue from 160 adult patients with biopsy-proven NASH from Singapore General Hospital (SGH) and Peking University People\u2019s Hospital (PKUH) were used. A consensus read by two expert hepatopathologists was organized. The refined qFibrosis algorithm incorporated the creation of a periportal region that allowed for the increased detection of periportal fibrosis. Consequently, an additional 28 periportal parameters were added, and 28 pre-existing perisinusoidal parameters had altered definitions. Results: Twenty-eight parameters (20 periportal and 8 perisinusoidal) were significantly different between the F1 and F2 cases that prompted a change of stage after a careful consensus read. The discriminatory ability of these parameters was further demonstrated in a comparison between the true F1 and true F2 cases as 26 out of the 28 parameters showed significant differences. These 26 parameters constitute a novel sub-algorithm that could accurately stratify F1 and F2 cases. Conclusion: The refined qFibrosis algorithm incorporated 26 novel parameters that showed a good discriminatory ability for NASH fibrosis stage 1 and 2 cases, representing an invaluable assistive tool for in-house pathologists when screening patients for NASH clinical trials.<\/jats:p>","DOI":"10.3390\/diagnostics10090643","type":"journal-article","created":{"date-parts":[[2020,8,28]],"date-time":"2020-08-28T09:17:08Z","timestamp":1598606228000},"page":"643","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["An Improved qFibrosis Algorithm for Precise Screening and Enrollment into Non-Alcoholic Steatohepatitis (NASH) Clinical Trials"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6003-9837","authenticated-orcid":false,"given":"Wei-Qiang","family":"Leow","sequence":"first","affiliation":[{"name":"Department of Anatomical Pathology, Singapore General Hospital, Singapore 169856, Singapore"},{"name":"Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre","family":"Bedossa","sequence":"additional","affiliation":[{"name":"Department of Pathology, Beaujon Hospital Paris Diderot University, 92110 Clichy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Liu","sequence":"additional","affiliation":[{"name":"Peking University People\u2019s Hospital, Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Beijing International Cooperation Base for Science and Technology on NAFLD Diagnosis, Beijing 100044, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lai","family":"Wei","sequence":"additional","affiliation":[{"name":"Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing 100084, China"},{"name":"Institute for Precision Medicine, Tsinghua University, Beijing 100084, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiat-Hon","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Anatomical Pathology, Singapore General Hospital, Singapore 169856, Singapore"},{"name":"Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei-Keat","family":"Wan","sequence":"additional","affiliation":[{"name":"Department of Anatomical Pathology, Singapore General Hospital, Singapore 169856, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yayun","family":"Ren","sequence":"additional","affiliation":[{"name":"HistoIndex Pte. Ltd., Singapore 139955, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2702-8412","authenticated-orcid":false,"given":"Jason Pik-Eu","family":"Chang","sequence":"additional","affiliation":[{"name":"Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore"},{"name":"Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore 169608, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chee-Kiat","family":"Tan","sequence":"additional","affiliation":[{"name":"Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore"},{"name":"Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore 169608, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3107-7599","authenticated-orcid":false,"given":"Aileen","family":"Wee","sequence":"additional","affiliation":[{"name":"Department of Pathology, National University Hospital, Singapore 119074, Singapore"},{"name":"Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George Boon-Bee","family":"Goh","sequence":"additional","affiliation":[{"name":"Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore"},{"name":"Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore 169608, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,8,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"(2016). 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