Role of percutaneous liver biopsy in infantile cholestasis: cohort from Arabs
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...
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| Format: | Article |
| Language: | English |
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BMC
2021-03-01
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| Series: | BMC Gastroenterology |
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| Online Access: | https://doi.org/10.1186/s12876-021-01699-4 |
| _version_ | 1818619319034052608 |
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| author | Amna Basheer M. Ahmed Musa Ahmad Fagih Muhammed Salman Bashir Abdulrahman Abdullah Al-Hussaini |
| author_facet | Amna Basheer M. Ahmed Musa Ahmad Fagih Muhammed Salman Bashir Abdulrahman Abdullah Al-Hussaini |
| author_sort | Amna Basheer M. Ahmed |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-16T17:35:35Z |
| format | Article |
| id | doaj.art-7e3a5dfaf0d449c5a8612f131b96dfeb |
| institution | Directory Open Access Journal |
| issn | 1471-230X |
| language | English |
| last_indexed | 2024-12-16T17:35:35Z |
| publishDate | 2021-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Gastroenterology |
| spelling | doaj.art-7e3a5dfaf0d449c5a8612f131b96dfeb2022-12-21T22:22:48ZengBMCBMC Gastroenterology1471-230X2021-03-0121111110.1186/s12876-021-01699-4Role of percutaneous liver biopsy in infantile cholestasis: cohort from ArabsAmna Basheer M. Ahmed0Musa Ahmad Fagih1Muhammed Salman Bashir2Abdulrahman Abdullah Al-Hussaini3The Division of Pediatric Gastroenterology, Children’s Specialized Hospital, King Fahad Medical CityDepartment of Pathology and Laboratory Medicine, King Saud Medical CityDepartment of Biostatistics, Research Services Administration, King Fahad Medical CityThe Division of Pediatric Gastroenterology, Children’s Specialized Hospital, King Fahad Medical CityAbstract 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.https://doi.org/10.1186/s12876-021-01699-4Liver biopsyPathologyIndicationsInfantSaudi ArabiaCholestasis |
| spellingShingle | Amna Basheer M. Ahmed Musa Ahmad Fagih Muhammed Salman Bashir Abdulrahman Abdullah Al-Hussaini Role of percutaneous liver biopsy in infantile cholestasis: cohort from Arabs BMC Gastroenterology Liver biopsy Pathology Indications Infant Saudi Arabia Cholestasis |
| title | Role of percutaneous liver biopsy in infantile cholestasis: cohort from Arabs |
| title_full | Role of percutaneous liver biopsy in infantile cholestasis: cohort from Arabs |
| title_fullStr | Role of percutaneous liver biopsy in infantile cholestasis: cohort from Arabs |
| title_full_unstemmed | Role of percutaneous liver biopsy in infantile cholestasis: cohort from Arabs |
| title_short | Role of percutaneous liver biopsy in infantile cholestasis: cohort from Arabs |
| title_sort | role of percutaneous liver biopsy in infantile cholestasis cohort from arabs |
| topic | Liver biopsy Pathology Indications Infant Saudi Arabia Cholestasis |
| url | https://doi.org/10.1186/s12876-021-01699-4 |
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