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Histopathological features and accuracy for diagnosing biliary atresia by prelaparotomy liver biopsy in developing countries
Author(s) -
Rastogi Archana,
Krishnani Narendra,
Yachha Surender Kumar,
Khanna Vikrant,
Poddar Ujjal,
Lal Richa
Publication year - 2009
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/j.1440-1746.2008.05737.x
Subject(s) - medicine , biliary atresia , liver biopsy , laparotomy , biopsy , histopathology , percutaneous , neonatal cholestasis , gastroenterology , radiology , cholestasis , neonatal hepatitis , bile duct , pathology , liver transplantation , transplantation
Background and Aim: 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. Conclusion: 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.