---
title: >-
  Heterogeneous Documentation and Poor Concordance of NASH Pathology May Limit
  its Clinical Utility in Real-World Practice.
description: >-
  Explore this publication on real-world evidence: Heterogeneous Documentation
  and Poor Concordance of NASH Pathology May Limit its Clinical Utility in…
date: '2020-01-01'
category: Publications
tags:
  - AASLD
  - Poster Presentation
  - Approval / Commercialization
  - Care
  - Hepatology
  - MASH/MASLD
  - Health System Partner
canonical_url: >-
  https://www.pedestalhealth.com/resources/publications/aasld/heterogeneous-documentation-and-poor-concordance-of-nash/
source: Pedestal Health
license: © 2026 Pedestal Health. All rights reserved.
slug: heterogeneous-documentation-and-poor-concordance-of-nash
id: 2KmCK1gQapABd6e9D1SVeV
contentType: article
---

## Challenge

Liver biopsy-based NASH diagnosis is only as reliable as the quality and completeness of the pathology reports generated in routine practice, yet the degree of heterogeneity and incompleteness in real-world NASH pathology documentation had never been systematically audited at scale.

## Solution

NASH-related pathology reports from 14 TARGET-NASH sites were audited for documentation completeness, and a subset of biopsy slides were centrally re-read, with concordance between local and central pathologists assessed using weighted kappa statistics across all key histological features.

## Impact

Documenting that critical NASH histological features are routinely missing from real-world pathology reports—and that local-central concordance is only fair to moderate—establishes the evidence base for mandatory central reading and standardized reporting in NASH drug development, directly informing regulatory guidance expectations.

### [Andrea R. Mospan](/people/andrea-mospan/)

![Andrea R. Mospan, PhD, RAC — Profile Photo](https://images.ctfassets.net/h4s3ip99qawo/4w6bkwPHPqrXKYs4tHZPkK/1d21763b54ecc3466764986693b7072f/andrea-mospan.jpg)