Classification tool for the systematic histological assessment of hepatocellular carcinoma, macroregenerative nodules, and dysplastic nodules in cirrhotic liver

Table 3 Classification tool for hepatocellular lesions in cirrhotic liver. Assess each individual histological feature (as per Table 1) and go to Table 4a

Column 1	Column 2	Column 3	Column 4
HCC	DN or MRN	DN	MRN
	Vascular invasion not present	Capillarization score 3, 4, or 5	Capillarization score 0, 1, or 2
	Capsular invasion not present	Cellular atypia score 1, 2, 3, 4, or 5	Cellular atypia score 0
Necrosis present	Necrosis not present	Reticulin loss score 1, 2, 3, 4, or 5	Reticulin loss score 0
Mitosis present	Mitosis not present	Trabecular thickness >3	Trabecular thickness <4
Capillarization score 4 or 5	Capillarization Score 0, 1, 2 or 3	Solitary arterioles ≥1	Solitary arterioles <1
Cellular atypia score 3, 4, or 5	Cellular atypia score 0, 1, or 2	Heterogeneity present	Heterogeneity absent
Reticulin loss score 1, 2, 3, 4, or 5	Reticulin loss score 0	Necrosis present
Trabecular thickness>3	Trabecular thickness<4	Mitosis present
Solitary arterioles ≥1	Solitary arterioles<1
Heterogeneity present	Heterogeneity absent

3a HCC vs DN/MRN If the given lesion is not HCC according to this table, Table 3b provides guidance regarding the assignment of DN vs MRN. 3b DN vs MRN. The nodule is DN, if the number of features in the “DN, column 3” is higher than the number of the features in the “MRN, column 4” and vice versa. In case of an even balance, the nodule is regarded as DN HCC, hepatocellular carcinoma; DN, dysplastic nodule; MRN, macroregenerative nodule.