Abstract
BackgroundInvestigators from different parts of the world are calling for a re-evaluation of the role of liver biopsy (LB) in the evaluation of infantile cholestasis (IC), especially in the light of emerging non-invasive diagnostic technologies. Therefore, this retrospective single-center study was conducted to determine the impact of LB on the diagnosis and management of IC in a cohort from Arabs.MethodsFrom 2007 until 2019, 533 cases of IC were referred for evaluation. All infants who underwent LB were included in the study. We categorized the yield of LB into: (1) defined specific diagnosis; (2) excluded an important diagnosis. A single pathologist reviewed and made the histology report.Results122 LB specimens met the inclusion criteria. The main indication for LB was a high suspicion of biliary atresia (BA) [high gamma-glutamyl transferase (GGT) cholestasis and pale stool] in 46 cases (37.8%). Liver biopsy had sensitivity of 86.4%, specificity (66.7%), PPV (70.4%), NPV (84.2%) in diagnosing BA. LB had a direct impact on clinical management in 52 cases (42.6%): (1) The true diagnosis was suggested by LB in 36 cases; (2) LB excluded BA and avoided intraoperative cholangiogram in 16 cases with high suspicion of BA. Among the 76 cases with low suspicion of BA, LB suggested the true diagnosis or helped to initiate specific management in 8 cases only (10.5%). In contrast, molecular testing confirmed the diagnosis in 48 (63%).ConclusionLB continues to be an important tool in the workup of cases with a high suspicion of BA. The low yield of LB in cases with low suspicion of BA calls for a re-evaluation of its role in these cases in whom early incorporation of cholestasis sequencing gene panels can have a better diagnostic yield.
Highlights
Histological examination of liver tissue has long been considered the cornerstone of the diagnostic workup of infants with cholestatic jaundice as recommended in both the old and most recent guidelines by the North American (NASPGHAN) and European society of pediatric gastroenterology, hepatology, and nutrition (ESPGHAN)[1, 2]
We retrospectively reviewed our database of cholestasis cases that presented to our center in Riyadh city, the capital of Saudi Arabia, during the period from 2007 until 2019
All infants presenting to our center with cholestasis undergo extensive work up to exclude infectious, structural, metabolic, endocrine, infiltrative and familial causes by following a diagnostic algorithm very similar to the guidelines endorsed by the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) [2]
Summary
Histological examination of liver tissue has long been considered the cornerstone of the diagnostic workup of infants with cholestatic jaundice as recommended in both the old and most recent guidelines by the North American (NASPGHAN) and European society of pediatric gastroenterology, hepatology, and nutrition (ESPGHAN)[1, 2]. The liver in neonates and young infants is vulnerable to insults of different causes and usually responds to injury by manifesting cholestasis with considerable overlap in biochemical and histological features. Investigators from different parts of the world are calling for a re-evaluation of the role of liver biopsy (LB) in the evaluation of infantile cholestasis (IC), especially in the light of emerging non-invasive diagnostic technolo‐ gies.
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