Steatotic Liver Disease: Navigating Pathologic Features, Diagnostic Challenges, and Emerging Insights

Area of Science:

• Hepatology and Pathology

Background:

• Steatotic liver disease (SLD) is an umbrella term for liver conditions characterized by fat accumulation.
• It now encompasses five distinct subcategories: metabolic dysfunction-associated steatotic liver disease (MASLD), metabolic and alcohol related/associated liver disease (MetALD), alcohol-related/associated liver disease (ALD), SLD with specific etiology, and cryptogenic SLD.

Purpose of the Study:

• To review foundational and recent advances in the histologic evaluation of steatotic liver disease (SLD).
• To discuss common pathologic features, diagnostic distinctions among etiologies, and scoring systems for SLD.
• To explore the role of digital pathology in SLD assessment.

Main Methods:

• Literature review of foundational and recent studies on SLD histology.
• Analysis of pathologic features and diagnostic criteria across SLD subcategories.
• Examination of current and emerging digital pathology techniques.

Main Results:

• SLD classification has evolved to include MASLD, MetALD, ALD, and other specific etiologies.
• Histologic evaluation requires recognizing common features and etiology-specific distinctions.
• Digital pathology offers new avenues for standardized and accurate SLD assessment.

Conclusions:

• Accurate histologic assessment is crucial for classifying and managing diverse forms of SLD.
• Standardized scoring and grading systems, aided by digital pathology, are essential for consistent SLD diagnosis.
• Understanding the nuances of SLD subtypes, including MASLD, is key for effective patient care.