Why imaging and biopsy are vital in paediatric diagnosis

Imaging and biopsy play a crucial role in paediatric diagnosis as they help doctors detect underlying conditions early, guide treatment, and ensure accurate care for children. (Image: Pexels)

The diagnosis of diseases in children is a science as well as an art which requires precision, patience and precise knowledge of children’s physiology. In contrast to adults, where the symptom-based diagnosis is challenging due to this coexistence of atypical symptoms, it is much more difficult to diagnose pathological reflux in children, where it is often impossible to define what children are experiencing. Furthermore, diseases in children may be more atypical in presentation, with nuances of subtle signs that warrant careful scrutiny.

In order to compensate for these limitations, doctors have to use sophisticated diagnostic procedures like imaging tests, laboratory tests, and biopsies. Imaging methods such as X-rays, ultrasounds, CT (computed tomography) scans or MRIs (magnetic resonance imaging) make it possible for doctors to see the inside of our bodies and find abnormalities without having to cut us open.

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Together with clinical knowledge, such technologies support early diagnosis and adequate treatment, says Dr Mallika Dixit, Deputy Lab Director and Quality Head, CORE Diagnostics (Gurgaon).

1. Why it is difficult to diagnose diseases in children:

Pain, fever, lethargy, or loss of appetite can be anything, anything from a minor viral infection to cancer.
Physical examination alone is usually not enough to show underlying conditions.

2. Imaging: Seeing without cutting:

Doctors use imaging tests to see inside the body without surgery:

• Ultrasound: Pain-free, radiation-free; used to guide biopsies or to drain fluid.

• MRI: Takes detailed pictures of the brain, spine, and muscles.

• CT Scan: Most important in emergencies to identify trauma, bleeding, lung masses, fractures, or tumour staging. Limitation: more radiation.

• X-rays: Rapid, easy, and needed for bone and lung scans.

A biopsy is a tissue sample obtained for microscopic examination to establish whether a lesion is benign, cancer, inflammation, or infection.

Ideal for children: Least invasive and safest.
Image-guided biopsies: Particularly valuable for deep-seated masses (liver, kidney, retroperitoneal or mediastinal lesions).
No scan can be substituted for a biopsy in the diagnosis of leukaemia or lymphoma.

4. Why imaging and biopsies go together:

Imaging gives the "big picture", location, and extent of disease.
Biopsies give the "microscopic truth", the precise nature of cells.
Without imaging, biopsies might miss the target. Without biopsies, imaging results may remain inconclusive.

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5. Examples of diagnostic accuracy:

• Bone pain can be pseudocancer but can be benign (e.g., osteoid osteoma, stress fracture).

• LCH and osteomyelitis can be mimicked on imaging by Ewing sarcoma.

• Biopsy with immunohistochemistry makes diagnosis; PET scans follow response to treatment.

Besides diagnosis, biopsy tissue propels molecular testing, FISH, PCR, and NGS, and aids in the identification of genetic alterations and facilitates personalized treatments of childhood cancer.

Imaging shows them what is going on in a child's body, and biopsies tell them why. Combined, they allow for quicker, more accurate, and empathetic paediatric diagnosis.

Disclaimer: This article, including health and fitness advice, only provides generic information. Don’t treat it as a substitute for qualified medical opinion. Always consult a specialist for specific health diagnosis.