Porto-sinusoidal vascular disorder (PSVD): Survey-based analysis of the usage and drawbacks of this newly proposed terminology

The term “porto-sinusoidal vascular disorder” (PSVD) has been proposed for morphologic findings commonly seen in non-cirrhotic portal hypertension (PH) but can also be observed without clinically evident PH. To assess current practice patterns among U.S. liver pathologists, a 16-question survey was distributed along with two publications outlining the PSVD proposal. Nearly all respondents (n = 22, 95.75 %) were familiar with the PSVD terminology, but only 5 (21.75 %) used it as a final diagnosis, while 11 (47.75 %) had never used the term. In the presence of PH, 17 (74 %) preferred “obliterative portal venopathy”, while only 1 (4.25 %) used PSVD. Notably, fewer than 5 % used PSVD in the context of nodular regenerative hyperplasia or incomplete septal fibrosis, although these have been proposed as part of the diagnostic criteria. A significant majority (n = 18, 78.25 %) disagreed with the proposed PSVD terminology, citing the following key concerns: labelling it as a disease entity is misleading (n = 20, 87 %), proposed diagnostic criteria are not supported by data (n = 15, 65.25 %), and labelling a process as PSVD does not seem accurate when only portal vein (n = 12, 52.25 %) or sinusoidal (n = 16, 69.5 %) changes are present. Over half (n = 13, 56.5 %) found it arbitrary to exclude certain vascular diseases from definition of PSVD (e.g., hepatic vein obstruction, sarcoidosis, schistosomiasis), given frequent histologic overlap across pre-hepatic, sinusoidal and post-hepatic etiologies of PH. In conclusion, “PSVD” terminology has not been adopted as a diagnostic term by most US liver pathologists who participated in this survey, emphasizing the need for a clearer, evidence-based terminology to describe these vascular changes.