Peer-Reviewed Publication
Histopathology2026September 4, 2026Journal Article

Visual steatosis assessment: method-dependent variation and systematically higher estimates compared with AI measurement.

Saadiya Nazli1, Abdelrahman Shaaban2, Ameya Patil1, Lindsey Smith3, Lucas Stetzik4, Bashar Hasan5, Rofyda Elhalaby1, Adilson DaCosta1, Priya Sivasubramaniam6, Byoung Uk Park7, Murli Krishna8, Marcela Salomao9, Rish Pai10, Maxwell Smith9, Daniela Allende11, Christopher P Hartley1, Hee Eun Lee1, Zongming Eric Chen1, Kristina A Matkowskyj1, Rondell P Graham1, Roger K Moreira1
1Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA.
2Department of Pathology, University of Virginia, Charlottesville, Virginia, USA.
3MySME, Birmingham, Alabama, USA.
4Aiforia Technologies, Rochester, Minnesota, USA.
5Department of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, Minnesota, USA.
6Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
7Department of Pathology, University of Minnesota, Minneapolis, Minnesota, USA.
8Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, Florida, USA.
9Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Arizona, USA.
10Department of Laboratory Medicine and Pathology, University of Toronto, Toronto, Ontario, Canada.
11Department of Pathology, Cleveland Clinic, Cleveland, Ohio, USA.

Abstract

AIMS: 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. METHODS AND RESULTS: Ten experienced liver pathologists from four institutions evaluated a limited set of 20 pe…

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