Clinicopathological spectrum and diagnostic contribution of liver biopsy in children: a prospective observational study from a tertiary care hospital

Abstract

Background: Liver biopsy remains an important reference standard for histopathological assessment of selected pediatric liver diseases despite advances in non-invasive investigations. It provides important histopathological diagnosis, assesses disease severity, and guides management. This study evaluated the clinicopathological spectrum and diagnostic contribution of liver biopsy in children. Methods: This prospective observational study included 25 children aged 1 month to 12 years who underwent percutaneous liver biopsy for suspected liver disease at a tertiary care teaching hospital in Gujarat, India, between September 2006 and September 2008. Demographic, clinical, laboratory, ultrasonographic, and histopathological findings were analysed using descriptive statistics. Diagnostic contribution was defined as confirmation of the suspected diagnosis, establishment of a previously unconfirmed diagnosis, or exclusion of intrinsic hepatic disease. Results: Twenty-five children underwent liver biopsy, with a male-to-female ratio of 1.5:1. Jaundice (80%), fever (76%), pallor (64%), and hepatomegaly (100%) were the most common clinical features. Hyperbilirubinemia (80%), elevated alanine aminotransferase (72%), hypoalbuminemia (44%), and prolonged prothrombin time (12%) were the predominant laboratory abnormalities. On histopathology chronic hepatitis and its variants were present in 11 (44%) children, including cirrhosis in 2 (8%) children, followed by acute inflammatory liver disease (20%), neonatal hepatitis (8%), metabolic liver disease (8%), hemolytic disorders (8%), portal triaditis (4%), and normal liver histology (8%). Liver biopsy established or confirmed the diagnosis and provided clinically important additional information in 92% of children, including assessment of inflammatory activity and fibrosis, differentiated overlapping disorders, and excluded intrinsic hepatic disease in selected cases. Conclusions: Liver biopsy remains an important diagnostic tool in pediatric liver disease. When interpreted alongside clinical, laboratory, and imaging findings, it contributes to diagnostic clarification and disease staging, particularly in chronic liver disease, neonatal cholestasis, and suspected metabolic liver disorders. The findings should be interpreted in the historical context of pediatric hepatology during 2006-2008.