Evaluation of Liver Biopsies using Histopathological Scoring System in Neonatal Hepatitis and Biliary Atresia: Correlation with Clinico-Radiological and Biochemical Parameters

Abstract

Introduction: Biliary Atresia (BA) and Neonatal Hepatitis (NH) are common causes of Neonatal Cholestasis (NC). There is a high degree of overlap between clinical and other investigational characteristics of BA and NH. Aim: To study the histopathological features of liver biopsies in cases of NC syndromes and to apply a histopathological scoring system in differentiating BA from other causes of NC. Materials and Methods: This study included 51 cases of NC (BA=25, NH=26) from Jan 2010 to June 2014. A scoring system, devised by Lee WS and Looi LM was applied to all the cases. Clinical, biochemical, Hepatobiliary scan (HIDA scan) and Peroperative Cholangiogram (POC) details of all the patients were collected. Results: Liver biopsy showed moderate to marked bile ductular proliferation in 24 (96%), bile plugging in 13 (52%), portal expansion in >50% of portal tracts in 19 (76%) and moderate/ severe lymphocytic infiltration in 15 (60%) cases of BA. Diffuse giant cell transformation and hepatocytic swelling were present in 19 (73%) and 22 (85%), respectively of NH. Score of ≥7 was helpful in differentiating BA from NH with 92% sensitivity and 96% specificity. Non-excretion of dye in the HIDA scan had 91% sensitivity and 65% specificity for the score of ≥7 which favoured the diagnosis of BA. POC was taken as the gold standard. Conclusion: A detailed histomorphology of liver biopsy along with a Lee and Looi score of ≥7 was helpful in differentiating BA from NH.

Keywords

• bile ductular proliferation
• cholangiogram
• hepatobiliary scan