The Sensitvity, Specificity, Positive and Negative Predictive Values of Stool Color test, Triangular Cord Sign and Hepatobiliary Scintigraphy in Diagnosis of Infantile Biliary Atresia

Background: It is very important to detect biliary atresia in a timely manner to prevent progressive damage to the liver. Our attempt was to formulate our diagnostic approach to infantile cholestasis in Mofid Children's Hospital in Iran. Methods: Forty two records of infants with prolonged conjugated cholestatic jaundice from 2003 to 2008 were reviewed with regard to the infants’ gestational age, birth-weight, stool color, liver function test results (total bilirubin, direct bilirubin, ALT, AST, alkaline phosphatase, albumin, globulin, and cholesterol), ultrasonography, hepatobiliary scintigraphy findings, liver biopsy results and ultimately intra-operative cholangiographies (IOC). Results: Total bilirubin, direct bilirubin, AST, AST to ALT ratio, cholesterol, and globulin were significantly higher in infants with biliary atresia (BA) as compared to those in the other group. We found that gestational age and birth weight were significantly lower in infants without BA. Stool color sensitivity, specificity, positive predictive value, and negative predictive value in diagnosis of BA were 100%, 83%, 81%, and 100%, respectively. These figures for triangular cord (TC) sign were 72%, 91%, 86%, 81%, respectively and for hepatobiliary scintigraphy were 100%, 85%, 100%, and 85%, respectively. Conclusion: In biliary atresia, history, physical exam, and liver function tests can be the first steps in diagnostic algorithms followed by colored stool. However, if TC is not visualized, hepatobiliary scintigraphy is suggested. If excretion of tracer does not occur, liver biopsy is indicated. The definite diagnosis would be possible by an intraoperative cholangiography