Role of Percutaneous Liver Biopsy in Infantile Cholestasis: Cohort from Arabs

Overview

Journal BMC Gastroenterol

Publisher Biomed Central

Specialty Gastroenterology

Date 2021 Mar 13

PMID 33711954

Citations 3

Authors

Amna Basheer M Ahmed

Musa Ahmad Fagih

Muhammed Salman Bashir

Abdulrahman Abdullah Al-Hussaini

Affiliations

Soon will be listed here.

Abstract

Background: 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 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.

Methods: From 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.

Results: 122 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%).

Conclusion: LB 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.

Citing Articles

Patterns and unique features of infantile cholestasis among Arabs.

Al-Hussaini A, Alrashidi S, Hafez D, Alkhalifah Y, Otayn B, Alrasheed M Front Pediatr. 2024; 12:1423657.

PMID: 39139600 PMC: 11319143. DOI: 10.3389/fped.2024.1423657.

Clinical and laboratory features of biliary atresia and patterns of management practices: Saudi national study (2000-2018).

Alhebbi H, El-Edreesi M, Abanemai M, Saadah O, Alhatlani M, Halabi H Saudi J Gastroenterol. 2023; 30(2):89-95.

PMID: 37706420 PMC: 10980299. DOI: 10.4103/sjg.sjg_151_23.

Clinical, Biochemical, and Molecular Characterization of Neonatal-Onset Dubin-Johnson Syndrome in a Large Case Series From the Arabs.

Al-Hussaini A, Alsaleem B, AlHomaidani H, Asery A, Alruwaithi M, Alameer M Front Pediatr. 2021; 9:741835.

PMID: 34858902 PMC: 8631451. DOI: 10.3389/fped.2021.741835.

References

Lai M, Chang M, Hsu S, Hsu H, Su C, Kao C . Differential diagnosis of extrahepatic biliary atresia from neonatal hepatitis: a prospective study. J Pediatr Gastroenterol Nutr. 1994; 18(2):121-7. DOI: 10.1097/00005176-199402000-00001. View

Talachian E, Bidari A, Mehrazma M, Nick-khah N . Biopsy-driven diagnosis in infants with cholestatic jaundice in Iran. World J Gastroenterol. 2014; 20(4):1048-53. PMC: 3921528. DOI: 10.3748/wjg.v20.i4.1048. View

Russo P, Magee J, Anders R, Bove K, Chung C, Cummings O . Key Histopathologic Features of Liver Biopsies That Distinguish Biliary Atresia From Other Causes of Infantile Cholestasis and Their Correlation With Outcome: A Multicenter Study. Am J Surg Pathol. 2016; 40(12):1601-1615. PMC: 5123664. DOI: 10.1097/PAS.0000000000000755. View

Chaudhry Z, Forget S, Nguyen V, Ahmed N . The Role of Liver Biopsy in Investigation of Cholestatic Liver Disease in Infancy. J Can Assoc Gastroenterol. 2019; 2(2):51-56. PMC: 6507280. DOI: 10.1093/jcag/gwy026. View

Moyer V, Freese D, Whitington P, Olson A, Brewer F, Colletti R . Guideline for the evaluation of cholestatic jaundice in infants: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr. 2004; 39(2):115-28. DOI: 10.1097/00005176-200408000-00001. View

Rastogi A, Krishnani N, Yachha S, Khanna V, Poddar U, Lal R . Histopathological features and accuracy for diagnosing biliary atresia by prelaparotomy liver biopsy in developing countries. J Gastroenterol Hepatol. 2009; 24(1):97-102. DOI: 10.1111/j.1440-1746.2008.05737.x. View

Liu C, Aronow B, Jegga A, Wang N, Miethke A, Mourya R . Novel resequencing chip customized to diagnose mutations in patients with inherited syndromes of intrahepatic cholestasis. Gastroenterology. 2007; 132(1):119-26. PMC: 2190109. DOI: 10.1053/j.gastro.2006.10.034. View

Lee W, Looi L . Usefulness of a scoring system in the interpretation of histology in neonatal cholestasis. World J Gastroenterol. 2009; 15(42):5326-33. PMC: 2776861. DOI: 10.3748/wjg.15.5326. View

Yang L, Zhou Y, Xu P, Mourya R, Lei H, Cao G . Diagnostic Accuracy of Serum Matrix Metalloproteinase-7 for Biliary Atresia. Hepatology. 2018; 68(6):2069-2077. PMC: 6519383. DOI: 10.1002/hep.30234. View

10.

Chen H, Li H, Wu J, Wu S, Chen H, Yang Y . Panel-Based Next-Generation Sequencing for the Diagnosis of Cholestatic Genetic Liver Diseases: Clinical Utility and Challenges. J Pediatr. 2018; 205:153-159.e6. DOI: 10.1016/j.jpeds.2018.09.028. View

11.

Gottesman L, Del Vecchio M, Aronoff S . Etiologies of conjugated hyperbilirubinemia in infancy: a systematic review of 1692 subjects. BMC Pediatr. 2015; 15:192. PMC: 4654877. DOI: 10.1186/s12887-015-0506-5. View

12.

Nicastro E, Di Giorgio A, Marchetti D, Barboni C, Cereda A, Iascone M . Diagnostic Yield of an Algorithm for Neonatal and Infantile Cholestasis Integrating Next-Generation Sequencing. J Pediatr. 2019; 211:54-62.e4. DOI: 10.1016/j.jpeds.2019.04.016. View

13.

Shneider B, Brown M, Haber B, Whitington P, Schwarz K, Squires R . A multicenter study of the outcome of biliary atresia in the United States, 1997 to 2000. J Pediatr. 2006; 148(4):467-474. DOI: 10.1016/j.jpeds.2005.12.054. View

14.

Jiang J, Wang J, Shen Z, Lu X, Chen G, Huang Y . Serum MMP-7 in the Diagnosis of Biliary Atresia. Pediatrics. 2019; 144(5). DOI: 10.1542/peds.2019-0902. View

15.

Azar G, Beneck D, Lane B, Markowitz J, Daum F, Kahn E . Atypical morphologic presentation of biliary atresia and value of serial liver biopsies. J Pediatr Gastroenterol Nutr. 2002; 34(2):212-5. DOI: 10.1097/00005176-200202000-00020. View

16.

Holdar S, Alsaleem B, Asery A, Al-Hussaini A . Outcome of biliary atresia among Saudi children: A tertiary care center experience. Saudi J Gastroenterol. 2018; 25(3):176-180. PMC: 6526739. DOI: 10.4103/sjg.SJG_306_18. View

17.

Serinet M, Broue P, Jacquemin E, Lachaux A, Sarles J, Gottrand F . Management of patients with biliary atresia in France: results of a decentralized policy 1986-2002. Hepatology. 2006; 44(1):75-84. DOI: 10.1002/hep.21219. View

18.

Shagrani M, Burkholder J, Broering D, Abouelhoda M, Faquih T, El-Kalioby M . Genetic profiling of children with advanced cholestatic liver disease. Clin Genet. 2017; 92(1):52-61. DOI: 10.1111/cge.12959. View

19.

Nio M, Ohi R, Miyano T, Saeki M, Shiraki K, Tanaka K . Five- and 10-year survival rates after surgery for biliary atresia: a report from the Japanese Biliary Atresia Registry. J Pediatr Surg. 2003; 38(7):997-1000. DOI: 10.1016/s0022-3468(03)00178-7. View

20.

Russo P, Magee J, Boitnott J, Bove K, Raghunathan T, Finegold M . Design and validation of the biliary atresia research consortium histologic assessment system for cholestasis in infancy. Clin Gastroenterol Hepatol. 2011; 9(4):357-362.e2. PMC: 3400532. DOI: 10.1016/j.cgh.2011.01.003. View