Histopathological features and accuracy for diagnosing biliary atresia by prelaparotomy liver biopsy in developing countries

Rastogi, Archana; Krishnani, Narendra; Yachha, Surender Kumar; Khanna, Vivek; Poddar, Ujjal; Lal, Richa

doi:10.1111/j.1440-1746.2008.05737.x

Cited by 93 publications

(90 citation statements)

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“…Liver biopsy is one of the most important diagnostic steps in the evaluation of NC and may be performed safely even in the smallest infants with local anaesthesia and sedation [3,4] . Percutaneous liver biopsy has been found to be particularly helpful in infants suspected of having BA in developing countries [5] . Bile ductular proliferation, bile plugging, multinucleated giant cells, focal necrosis of liver parenchyma, extramedullary haemopoiesis and inflammatory cell infiltrate in the portal area are all well-recognised histological features of BA [3] .…”

Section: Introductionmentioning

confidence: 99%

Usefulness of a scoring system in the interpretation ofhistology in neonatal cholestasis

Lee¹,

Looi²

2009

WJG

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AIM:To ascertain the usefulness of a histological scoring system devised to assist in the interpretation of liver histology in neonatal cholestasis (NC). METHODS:Liver biopsy specimens obtained from infants with NC referred to a tertiary pediatric unit in Malaysia were prospectively studied. The first author, blinded to the final diagnosis, devised the histological diagnosis based on a 7-feature (portal ductal proliferation, bile plugs in portal ductules, portoportal bridging, lymphocytic infiltration in portal region, multinucleated hepatocytes, neutrophilic infiltration, hepatocellular swelling), 15-point (0 to 15) scoring system. The author classified the histological diagnosis as either biliary atresia (BA) or neonatal hepatitis (NH, all other diagnoses), and subsequently compared the author's diagnosis with the final diagnosis. RESULTS:Eighty-four biopsy specimens obtained from 78 patients were reviewed. Without the scoring system, BA was correctly diagnosed by the author histologically in 30 cases, labelled as NH in 3. For other diagnoses, BA was excluded correctly in 33 cases and mislabeled as BA in 2 cases. The overall sensitivity for BA was 91%, specificity 86% and accuracy 88%. With the scoring system, a score of ≥ 7 had the best diagnostic utility to differentiate BA from other intrahepatic cholestasis histologically (sensitivity 88%, specificity 94%, accuracy 92%). Four patients with a score < 7 had BA, and 3 patients with a score ≥ 7 had NH. CONCLUSION:A 7-feature, 15-point histological scoring system had good diagnostic accuracy in the interpretation of liver histology in neonatal cholestasis.

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Section: Introductionmentioning

confidence: 99%

Usefulness of a scoring system in the interpretation ofhistology in neonatal cholestasis

Lee¹,

Looi²

2009

WJG

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“…In contrast, features such as amount of EMH, lobular inflammation, and giant cell transformation were seen with similar frequency in biliary obstruction and other forms of neonatal cholestasis. Similarly, previous studies 78, 96,97 evaluating distinguishing histopathologic features between biliary atresia and neonatal hepatitis have consistently identified ductular reaction, ductal/ductular bile plugs, and portal-based fibrosis as key distinguishing findings in this scenario ( Table 2).…”

Section: Differential Diagnosis and Diagnostic Pitfallsmentioning

confidence: 99%

Biliary Atresia: A Multidisciplinary Approach to Diagnosis and Management

Moreira¹,

Cabral²,

Cowles³

et al. 2012

Archives of Pathology &Amp; Laboratory Medicine

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Context.—Biliary atresia is an inflammatory cholangiopathy of infancy that results in progressive fibrosis and obliteration of bile ducts and represents the main indication for liver transplant in young children. In spite of extensive investigation, its etiology has remained poorly understood. Timely surgical intervention (Kasai procedure) may result in significant benefit to these patients and represents the final goal of an accurate diagnostic evaluation. Objective.—To present an overview of biliary atresia, including clinical and surgical approaches to this disease, with emphasis on the histopathologic evaluation. Data Sources.—Review of relevant literature indexed in PubMed (US National Library of Medicine). Conclusion.—A well-coordinated multidisciplinary approach is required in the assessment of suspected cases of biliary atresia. Pathologic examination of biopsy specimens is an integral part of the diagnostic algorithm and, therefore, plays a pivotal role in the diagnostic evaluation of this disease.

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“…Negative ultrasonography and positive histology results should be able to establish the correct preoperative diagnosis in about 85% cases of BA [74]. In a series, an incorrect (typically giant-cell hepatitis) or non-specific biopsy diagnosis was reported in about 15% of those eventually shown to have BA [74]. Sensitivity and specificity of percutaneous liver biopsy for diagnosing BA has been reported as 88.2% each.…”

Section: Percutaneous Needle Biopsymentioning

confidence: 99%

“…Alpha 1-antitrypsin deficiency, Alagille's syndrome, and neonatal hepatitis) is a helpful investigation in diagnosis, but relies upon expert pathological interpretation. Negative ultrasonography and positive histology results should be able to establish the correct preoperative diagnosis in about 85% cases of BA [74]. In a series, an incorrect (typically giant-cell hepatitis) or non-specific biopsy diagnosis was reported in about 15% of those eventually shown to have BA [74].…”

Section: Percutaneous Needle Biopsymentioning

confidence: 99%

Revival of Landing's Concept of Infantile Obstructive Cholangiopathy A Plea to Hand Over the 2 Week Old Jaundiced Full Term Neonate to the Surgeon!

Sharma

Gupta

2014

J. paediatr. surg. Bangladesh

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:The concept of infantile obstructive cholangiopathy started in 1974 by Landing and remained till early 1980s. However, the concept has not been used much since then as nothing new has developed over the last 40 years sufficient enough to change the course of the disease or identify its etiology. This review article is an attempt to consolidate evidence on review of literature pointing towards a common etiopathological process leading to the spectrum of anomalies constituting neonatal cholestasis. The importance of early referral of any case with neonatal jaundice in a full term neonate, preferably at 2 weeks age is highlighted. This will help to identify and treat more cases within the correctable range and prevent the disease from progressing to a life threatening situation especially in developing countries where the resources for liver transplantation are meagre. Introduction:Newborn babies are at increased propensity for developing hyperbilirubinemia due to increased bilirubin production or its decreased excretion. The increased production is attributed to a greater red cell mass per kg as compared to adults and a shorter life span of red blood cells. The decreased excretion is attributed to defective uptake of bilirubin due to hepatic immaturity and decreased ligandin, defective conjugation due to decreased uridine diphospho glucuronyl transferase (UDPG-T) activity, decreased hepatic excretion of bilirubin and increased enterohepatic circulation due to higher levels of glucuronidase Review Article REVIVAL OF LANDING'S CONCEPT OF INFANTILE Physiological Jaundice:The physiologic jaundice seen in newborn babies appears on the third day of life and usually lasts till the tenth day in full term babies. It appears slightly earlier in preterm babies and may last upto two weeks. However, the serum bilirubin levels do not exceed 12 mg % in full term babies and 15 mg % in preterm babies. The normal range of total and conjugated bilirubin are <1 mg/dl and <0.25 mg/dl respectively, although jaundice can only be appreciated in newborn babies only when the total bilirubin is greater than 5 mg/dL Physiological jaundice may be accentuated by immaturity, birth asphyxia, acidosis, hypothermia, hypoglycemia, septicemia, blood group incompatibilities, drugs like salicylates, gentamycin, sulpha drugs, cephalhematoma, polycythemia, hypothyroidism intrauterine infections and breast milk jaundice. At high levels, unconjugated bilirubin can cross the blood-brain barrier and cause brain injury (kernicterus). The usual therapy for unconjugated jaundice is phototherapy and occasionally exchange transfusion. Neonatal Cholestasis :Infants with the persistence of jaundice beyond the physiologic limits, in the absence of an apparent medical cause, need to be investigated without much delay. The causes for Conjugated Hyperbilirubinemia (neonatal cholestasis) include obstructive and nonobstructive disorders. These are broadly called extrahepatic biliary obstruction and neonatal hepatitis. Cholestasis thus results from either to s...

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Histopathological features and accuracy for diagnosing biliary atresia by prelaparotomy liver biopsy in developing countries

Abstract: 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.

Cited by 93 publications

References 18 publications

Usefulness of a scoring system in the interpretation ofhistology in neonatal cholestasis

Usefulness of a scoring system in the interpretation ofhistology in neonatal cholestasis

Biliary Atresia: A Multidisciplinary Approach to Diagnosis and Management

Revival of Landing's Concept of Infantile Obstructive Cholangiopathy A Plea to Hand Over the 2 Week Old Jaundiced Full Term Neonate to the Surgeon!

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Histopathological features and accuracy for diagnosing biliary atresia by prelaparotomy liver biopsy in developing countries

Abstract: 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.

Cited by 93 publications

References 18 publications

Usefulness of a scoring system in the interpretation ofhistology in neonatal cholestasis

Usefulness of a scoring system in the interpretation ofhistology in neonatal cholestasis

Biliary Atresia: A Multidisciplinary Approach to Diagnosis and Management

Revival of Landing's Concept of Infantile Obstructive Cholangiopathy  A Plea to Hand Over the 2 Week Old Jaundiced Full Term Neonate to the Surgeon!

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Revival of Landing's Concept of Infantile Obstructive Cholangiopathy A Plea to Hand Over the 2 Week Old Jaundiced Full Term Neonate to the Surgeon!