Evaluation and Comparison of Histopathological Parameters between Core Needle Biopsy and Subcapsular Wedge Liver Biopsy in Children with Biliary Atresia: A Cross-sectional Study

Background: Percutaneous core needle biopsy (CNB) is used to diagnose biliary atresia (BA), while subcapsular wedge biopsy (WB) is a routine part of Kasai portoenterostomy (KPE). This study compares the histopathological features of CNB and WB, evaluates the necessity of CNB during KPE, and explores whether WB can be omitted if CNB has already been performed. Materials and Methods: A retrospective study was conducted at a tertiary care institute involving BA patients who underwent preoperative CNB and intraoperative WB from 2018 to 2023, analyzing and comparing histopathological parameters. Results: A total of 14 patients were included, all showing liver fibrosis on both CNB and WB. Portal inflammation (PI) and stromal edema (SE) were present in all on CNB. Ductular reaction (DR), ductular cholestasis, and lobular cholestasis (LC) were found in all but one patient. WB revealed a higher incidence of ductal plate malformation (DPM) and greater severity of fibrosis, DR, PI, and LC. In contrast, CNB showed a higher incidence of portal vein abortive (PVA) and more cellular death (CD). Conclusion: Specific histological parameters were more evident in CNB (PVA and CD), while others were more prominent in WB (fibrosis, DR, DPM, PI, and LC). Although CNB has a definitive diagnostic role preoperatively, it can be avoided along with intraoperative WB. In contrast, WB should be a routine part of KPE, regardless of preoperative CNB status.