A Study to Evaluate the Usefulness of a Seven Feature, Fifteen-Point Histological Scoring System in the Interpretation of Histology in Neonatal Cholestasis

Abstract

Introduction: Neonatal cholestasis (NC) affect one in 2500 live births and is an important cause of chronic liver disease in young children. Biliary atresia (BA) and neonatal hepatitis (NH) are the two major causes of NC. However, both conditions have entirely different therapeutic strategy and prognosis. The objective of the study was to evaluate the usefulness of a seven feature, fifteen-point histological scoring system in the interpretation of liver biopsy in NC and differentiating BA from NH. Methodology: Biopsy specimens of clinically diagnosed NC were reviewed histologically, first without and then with reference to a seven feature, fifteen-point histological scoring system. Statistical analysis was performed and sensitivity, specificity, and diagnostic accuracy of the histological scoring system were analyzed by comparing it with the final clinical diagnosis. Results: A total of 38 liver biopsies were reviewed using the scoring system, 25 cases were diagnosed as extra hepatic biliary atresia (EHBA) and 13 cases were diagnosed as other causes of NC. The overall sensitivity of this scoring system was 88.89%, specificity was 90.91%, positive predictive value was 96%, negative predictive value 76.92%, and diagnostic accuracy was 93.6%. Conclusion: Histological interpretation of liver biopsies based on a seven feature, fifteen-point histological scoring system has the highest sensitivity, specificity, and diagnostic accuracy to differentiate BA from other causes of intrahepatic cholestasis (Non-BA).

Keywords

• Biliary atresia, Diagnostic accuracy, Histologic scoring system, Liver biopsy, Neonatal cholestasis, Neonatal hepatitis