Liver biopsy in the differential diagnosis of cholestatic diseases in infants

Abstract

Liver biopsy (LB) is the most reliable source in the diagnosis of cholestatic liver diseases, the most informative in the prognosis of organ functioning after Kasai operation.

Aim - to establish the terms, conditions, age, and methods of LB in young children with cholestatic liver diseases to determine the differential diagnostic informativeness of histological studies.

Materials and methods. 118 children with jaundice aged 1.5-4.5 months underwent morphological examination of LB to verify the diagnosis.

Results. All LB met the standard (≥10 portal tracts). In 64 (54.2%) children histological examination revealed characteristic signs of biliary atresia (BA): characteristic features - ductal proliferation, fibrosis, inflammation, obliteration. Percutaneous LB at the age of 30 days provides diagnostic accuracy, confirmed by cholangiography and postoperative LB. Primary familial intrahepatic cholestasis (PFIC) is characterized by ductopenia, lobular infiltration, and hepatocyte necrosis. Tactics after 45-60 days of life become more complicated - laparoscopic LB with cholangiography and possible transition to Kasai operation (KO) is recommended if conditions are available.

Conclusions. LB is a key method in the differential diagnosis of neonatal cholestasis, especially when BA is suspected. In 92.1% of our patients, LB verified BA, which is consistent with the literature data. In cases of non-atresic forms of cholestasis, the morphological picture is less specific, so LB should be supplemented with genetic testing. The patient's age has a critical impact on informativeness: up to the 14^th day of life - low diagnostic value, on the 30^th day - the optimal period for performing LB. Conditions for effectiveness: high-quality biopsy (≥10 portal tracts), choice of the correct technique (puncture or laparoscopic), qualified morphological analysis in combination with clinical and laboratory data. These results emphasize the importance of timely and high-quality LB for determining further treatment tactics, including surgical intervention or molecular diagnostics.

The research was carried out in accordance with the principles of the Declaration of Helsinki. Informed consent of the child and child's parents was obtained for the research.

The authors declare no conflict of interest.