Histopathological features and accuracy for diagnosing biliary atresia by prelaparotomy liver biopsy in developing countries.
OBJECTIVE
A major challenge in neonatal cholestasis (NC) is to differentiate biliary atresia (BA) from other non-atretic causes. In developing countries there are considerable problems of late referral of NC cases and performing surgery without prelaparotomy liver biopsy that contributes to a high proportion of negative laparotomy and increased morbidity. We evaluated the hepatic histopathology for presence of features that correlate best with the diagnosis of BA and assessed the accuracy of percutaneous liver biopsy.


METHODS
Fifty-five cases of NC that fulfilled the selection criteria and had liver biopsy available were analyzed. Among the 49 adequate liver biopsies, 28 cases were diagnosed as BA, 15 neonatal hepatitis (NH) and 6 were due to other causes. Validity of percutaneous liver biopsy diagnoses was compared with confirmed cases by laparotomy findings and 1-year follow up. Twelve histological parameters of confirmed cases of BA and NH were evaluated by logistic regression analyses.


RESULTS
Ductular proliferation (P = 0.0002), bile duct and ductular bile plugs (P = 0.009), and portal fibrosis (P = 0.002) were the best indicators of BA and among them ductular proliferation was the most important in distinguishing BA from NH. Ductal plate malformation was observed in 17.9% cases of BA. Sensitivity and specificity of percutaneous liver biopsy for diagnosing BA was 88.2% each.


CONCLUSIONS
Percutaneous liver biopsy is highly accurate (88.2%) in diagnosing BA. In developing countries. This investigation should be done to decrease the frequency of negative laparotomy and to achieve cost-benefit with reduced morbidity.
Rastogi
Archana
A
Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Krishnani
Narendra
N
Yachha
Surender Kumar
SK
Khanna
Vikrant
V
Poddar
Ujjal
U
Lal
Richa
R
D001652:Bile Ducts / Q000473:pathology; D001656:Biliary Atresia / Q000150:complications / Q000473:pathology* / Q000601:surgery; D001706:Biopsy; D049109:Cell Proliferation; D003906:Developing Countries; D003937:Diagnosis, Differential; D005260:Female; D015726:Giant Cells / Q000473:pathology; D006505:Hepatitis / Q000150:complications / Q000473:pathology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D041781:Jaundice, Obstructive / Q000209:etiology* / Q000473:pathology; D007813:Laparotomy; D008099:Liver / Q000473:pathology* / Q000601:surgery; D008103:Liver Cirrhosis / Q000473:pathology; D016015:Logistic Models; D008297:Male; D011237:Predictive Value of Tests; D011300:Preoperative Care; D018570:Risk Assessment; D012680:Sensitivity and Specificity