Design and validation of the biliary atresia research consortium histologic assessment system for cholestasis in infancy.
OBJECTIVE
Pathologists participating in the National Institutes of Health-sponsored Biliary Atresia Research Consortium (BARC) developed and then evaluated a standardized system for histologic reporting of liver biopsies from infants with cholestasis.


METHODS
A set of 97 anonymous liver biopsy samples was sent to 10 pathologists at BARC centers. A semiquantitative scoring system that had 16 histologic features was developed and then used by the pathologists, who had no knowledge of clinical history, imaging results, or laboratory data. Interobserver agreement was evaluated statistically. Agreement on scoring of each feature and on the pathologists' diagnosis, compared with the final clinical diagnosis, was evaluated by using weighted kappa statistics.


RESULTS
There was moderate to substantial interobserver agreement in identification of bile plugs in ducts, giant-cell transformation, extramedullary hematopoiesis, and bile duct proliferation. The pathologists' diagnosis of obstruction in clinically proven cases of biliary atresia (BA) ranged from 79%-98%, with a positive predictive value of 90.7%. Histologic features that best predicted BA, on the basis of logistic regression, included bile duct proliferation, portal fibrosis, and absence of sinusoidal fibrosis (each P<.0001).


CONCLUSIONS
The BARC histologic assessment system identified features of liver biopsies from cholestatic infants, with good interobserver agreement, that might be used in diagnosis and determination of prognosis. The system diagnosed BA with a high level of sensitivity and identified infants with biliary obstruction with reasonable interobserver agreement. However, distinguishing between BA and disorders such as total parenteral nutrition-associated liver disease and alpha(1)-antitrypsin deficiency is not possible without adequate clinical information.
Department of Pathology and Laboratory Medicine, the Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Pierre
P
Russo
John C
JC
Magee
John
J
Boitnott
Kevin E
KE
Bove
Trivellore
T
Raghunathan
Milton
M
Finegold
Joel
J
Haas
Ronald
R
Jaffe
Grace E
GE
Kim
Margret
M
Magid
Hector
H
Melin-Aldana
Frances
F
White
Peter F
PF
Whitington
Ronald J
RJ
Sokol
D001656:Biliary Atresia / Q000175:diagnosis* / Q000473:pathology*; D001706:Biopsy; D002779:Cholestasis / Q000175:diagnosis* / Q000473:pathology*; D006651:Histocytochemistry / Q000379:methods* / Q000592:standards; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008099:Liver / Q000473:pathology; D012680:Sensitivity and Specificity
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