Efficacy of the seven feature, fifteen point histological scoring system and CD56 in interpretation of liver biopsies in persistent neonatal cholestasis: A five-year study.
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Date
2014-04
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Abstract
Context: Neonatal cholestasis (NC) lasting more than 2 weeks affects one in 2500
live births. Extrahepatic biliary atresia (EHBA) and idiopathic neonatal hepatitis
account for about 70% of all cases of NC. Differentiating these two conditions is
important as patient management is very different for both the conditions. Aims: To
assess the usefulness of the seven-feature, 15-point histological scoring system
in the interpretation of liver biopsy in NC and usefulness of immunostaining
with CD56 (N-CAM) in EHBA. Settings and Design: Retrospective study of 5
years’ duration at a pediatric referral institute, where the case load of NC is high
and defi nitive surgery for EHBA is undertaken after histological confi rmation.
Materials and Methods: The study is of a 5-year duration conducted between
June 2007 and May 2012. A total of 210 cases of NC were clinically diagnosed
during this period. All the slides were reviewed with reference to a seven-feature,
15-point histological scoring system assessing its usefulness in the interpretation
of liver biopsy in NC and utility of the immunohistochemical marker CD56 was
also assessed as an aid in the characterization of bile ductular proliferation in
EHBA. Statistical Analysis: Statistical analysis was performed and sensitivity and
specifi city of the histological scoring system for EHBA was analyzed. Results: Of the
210 liver biopsies reviewed using the scoring system, 122 cases were diagnosed as
EHBA and 88 cases were diagnosed as other causes of NC. The overall sensitivity of
this scoring system was 95.5%, specifi city was 93.1% and diagnostic accuracy was
94.6%. Conclusions: The seven-feature, 15-point histological scoring system has
good diagnostic accuracy in the interpretation of liver histology in NC as advanced
histopathological fi ndings even at younger age require immediate surgery. CD-56
is a useful marker in the assessment of bile ductular proliferation in EHBA.
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Keywords
CD56, EHBA, neonatal cholestasis
Citation
Krishna O H Radhika, Sultana Nadera, Malleboyina Ramani, Kumar A Narendra, Reddy K Ramesh, Rao Bhuwaneshwar N. Efficacy of the seven feature, fifteen point histological scoring system and CD56 in interpretation of liver biopsies in persistent neonatal cholestasis: A five-year study. Indian Journal of Pathology & Microbiology. 2014 Apr-Jun 57 (2): 196-200.