title: Histopathological features and accuracy for diagnosing biliary atresia by prelaparotomy liver biopsy in developing countries.
abstract: 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.
authors.affiliation: Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
authors.forename: Archana
authors.initials: A
authors.lastname: Rastogi
authors.forename: Narendra
authors.initials: N
authors.lastname: Krishnani
authors.forename: Surender Kumar
authors.initials: SK
authors.lastname: Yachha
authors.forename: Vikrant
authors.initials: V
authors.lastname: Khanna
authors.forename: Ujjal
authors.initials: U
authors.lastname: Poddar
authors.forename: Richa
authors.initials: R
authors.lastname: Lal
mesh_terms: 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