Pediatric Liver Biopsies Over a Decade: Patterns of Disease and Biochemical Associations

Background Liver biopsy remains the definitive diagnostic tool for pediatric liver disease, particularly when non-invasive assessments are inconclusive. This study aimed to characterize histopathological findings and associated laboratory abnormalities in a large pediatric cohort undergoing liver biopsy. Methods A retrospective cross-sectional study was conducted on 1,158 patients under 18 years of age who underwent liver biopsy at Mofid Children’s Hospital between 2011 and 2021. Data on demographics, biopsy type, histopathological findings, and laboratory parameters were extracted from medical records. Statistical analyses included descriptive statistics and group comparisons using chi-square, t-tests, and non-parametric tests. Results Ultrasound-guided needle biopsy was the most frequently performed technique (470, 40.6%). Predominant histopathological features included inflammatory infiltration (797, 68.8%), fibrosis (694, 59.9%), and feathery degeneration (607, 52.4%) (Fig. 1: distribution of common pathological findings ). Non-specific changes (252, 21.8%), metabolic liver disease (170, 14.7%), and Wilson’s disease (108, 9.3%) were the most common diagnoses (Fig. 3: common CLINICAL CONDITIONS ). Elevated aminotransferases were frequent (mean AST 230.43 U/L, mean ALT 166.00 U/L). Cirrhosis was significantly more prevalent in female patients (p = 0.002). Statistically significant associations were observed between biopsy type and specific histopathological findings (p < 0.001, Tables 2 & 3 ). Conclusion Despite advances in non-invasive diagnostics, liver biopsy remains crucial in pediatric hepatology. The findings underscore its diagnostic value, especially in cases with elevated liver enzymes or nonspecific clinical presentations, while highlighting the need for complementary non-invasive strategies.