Accuracy of Liver Biopsies

I guess I always need something new to worry about, so this week it's the accuracy of liver biopsies.  According to a Cleveland Clinic website
(http://www.clevelandclinicmeded.com/hcv/biopsy.htm):

"Liver biopsy remains an important tool in the baseline evaluation of the HCV-infected patient. A specimen of sufficient length (15 mm) and width (1.4 mm) that contains at least six portal areas is desired.  A recent study of "virtual biopsy specimens" confirmed that the amount of liver tissue available for the pathologist to review is critical. A biopsy length of 15 mm was 65% accurate in scoring the degree of fibrosis; a biopsy length of 25 mm was 75% accurate. Specimens longer than 15 mm that contain six or more portal areas correlate better with biochemical surrogate markers of fibrosis than do smaller specimens."


Well, talk about irony.  The Cleveland Clinic did my biopsy back in October and the sample they took was half the size that their own website recommends.  Sheesh!  What am I to make of that?  

Susan

[Indiana]

I've read a lot about biopsies over the years....before deciding not to get one myself. But my reasons for that had nothing to do with accuracy.
Biopsies have become a source of great debate within the medical community. The need for a better non-invasive test is obvious. They are close to having the same accuracy now with those newer tests that are in the trials.
From what I have read, the docs compensate for the lack of "overall accuracy" by picking the location carefully. They look at the reason for the biopsy(HCV, injury, infections,etc) and pick the location most likely to show the possible damage they are looking for.
Some also take multiple samples from different locations to get a better overall reading of the total liver condition.Ultrasound guidance has greatly aided in that plan.
Personally, I think that overall they are pretty accurate in most cases. I would only question the accuracy if it showed no damage or little damage and not if it showed major damage. Since most folks with little or no damage who decide to wait on treatment will get another biopsy in 3-5 years, I think it's still a pretty safe bet to believe it. The odds of 2 or more biopsies completely missing damage has GOT to be pretty danged low.
In your case, I would take that info you have right in to your doc or the clinic and ask them about it. There is probably some good reason why they took a smaller sample size. I would LOVE to hear what it is. I guess I'm just a nutball for the techical stuff.
Ya know, we all read a lot of medical "stuff" that on the surface can really freak us out if we let it. While I DO believe in keeping a sharp eye on our treatment and tests, I don't think we always relate everything together as well as the doctors can.
Let us know what they have to say.
Take care

[Sam Hall]

Both posts have it about right, after the skin there's no bigger organ, so without numerous  biopsies the degree of accuracy is questionable and perhaps not worth pusuing. The levels of damage appear to be idosicratic i.e hardened drinker low ...casual or abstinate 2-3. I agre that's the exception but look at me iv(heavy duty then 1/2 to1 bottle of single malt a day) mild fibrosis. Do the maximum dose of combo that you can take then get regular PCR 'til you are convinced. Then say Tallblonde to me a few more times for my pleasure.
Sam

[dartmouth03]

hey everyone...i'm having a liver biopsy next week and wanted to hear from people on here who have gone through the procedure before...any experiences both good and bad would be appreciated.  i've had fluctuating ALT levels since November that are usually around the 60-100 range...all the hep a,b and c and a bunch of other tests were all negative so they're doing a biopsy.  only positive thing was a slight anti smooth muscle antibody of 1:80 which is low according to my doctor...

any past experiences in regards to the Biopsy would be great.  i'm worried that i'll feel weak (like when you give a lot of blood)...thanks again and happy 4th.

best

alex

[Tallblonde]

Hi...and welcome to the board.  The liver biopsy is a piece of cake.  I'm a very nervous patient for even the simplest medical procedures and I got through the biopsy just fine.  Being sedated (but not unconscious) certainly helped. The hardest part was lying there for four hours afterwards.  Very boring.  You might have some discomfort in your right shoulder after the procedure.  This is very common and can be easily remedied with a painkiller.  

All in all, you'll find that the actual event doesn't come close to what you're imagining it will be like.  You'll be fine and it'll be a relief to finally know the condition of your liver.  I spent a month prior to the biopsy fearing the worst; I literally thought I had been handed a death sentance.  When the results showed no liver damage, I was ecstatic.  You may very well have good news awaiting you, too.  I hope so.

Best wishes!
Susan

[Tallblonde]

Thanks, guys, for your comments.  I guess I'll just have to have faith that my biopsy results are a reasonable representation of the actual condition of my liver.  You can drive yourself crazy worrying about some of this stuff.  And it's not like I can just pop in and ask them to re-do it next week.

_______

Sam:  ....tallblonde, tallblonde, tallblonde....

_______

Susan

[derail]

you just had to encourage sam, didn't you he will be drooling for hours hahahahahahaha

[Tallblonde]

The name "tallblonde" must bring sexy images of women like Claudia Schiffer or Darryl Hannah into Sam's mind.  But for all he knows, I may look more like Big Bird!  Actually, the reality is probably somewhere in the middle of those two extremes.  He'd have to ask my husband!


Susan

[dartmouth03]

thank you so much for sharing your experience w/ the biopsy.  i'm glad yours went well and the results were normal.  take care:)

best

alex

[derail]

Doesn't matter you are beautiful like all the people here.......


DARYL

[honey1616]

Yeah I also read about the fibrosure test and was interested in more about it or people that have actually done it.  I also read where dr cecil is using it and will report more on it.  I asked my dr but he didn't act like he was thrilled with it...

[cindee]

Susan I just had to say tallblonde for Sam, I think it was!!!! LOL
tallblonde...LOL...
Susan @ Alex, HI!!!! I had a bx by my new hepatologist about 4 wks ago now. It was soooooo easy for me. I asked to see the pieces he took out of me and they were a very pinkish color. They looked like they were about an inch long, but very thin, and it looked like maybe 5 or 6 in the bottle.

I know you don't loose much blood...there was a little blood on his gloves, but they only used a band aid to cover my bx. And I had very, very little bleeding, but I clot very quickly too.

See the bx was easy for me. My doctor ordered an ultra-sound to see where to get the bx's.  Then I was taken to a surgery rm..a small one. My doctor came in and we all, the nurses too started laughing we were all telling jokes.

Then my doctor was using his thumb to mash around my liver area...I jumped...and I was WRONG TO TELL HIM!!! "Oh that didn't hurt, I'm very ticklish"..and I had gotten lipstick on his white jacket @ our last apptmt. Well he decided to GET ME BACK!!!! He took all his fingers and tickled me until I peed my pants!!! Not much, but I was laughing, he was laughing, and all the nurses were laughing too.

I was wondering what all the people in the rooms beside us were thinking!?!?!? LOL Then he tells ya to breathe in and blow it out and hold still for a second or so, he did this about 5 or 6 times. Then it was over. That easy! Then they took me to a recovery room, where my nurse and hubby were waiting on me.....knowing I have tissue damage @ fibromyilgia...and am on 135 mg of morphine a day, he ordered a dimerol (spelling?) shot for me. She said she was going to go ahead and give it to me...and she was giving me the "high end" (see it was time for my morphine and she couldn't let me take it even though hubby had it in his pocket)...I guess meaning the highest doseage he had ordered for me. I was in no pain. A bit later my right shoulder hurt a bit for a couple or 3 days...then it was gone! So I has FUN with my bx. Hope yours are FUN too! LOVE and PRAYERS TO ALL!!!!!!!! Cindee

[nurse12hr]

You are on 135mg of MORPHINE A DAY?

Was that a typo?

[snook_man]

I thought most of the studies show that 48 weeks of peg show some reversal. Even that study of Italians with hep D, and chirrosis (cirrhosis) reversal, was only 48 weeks. Isn't the extension only for SVR?? Like I said before, you gotta have a liver like a five year old by now..

[Daria2]

Hi, and hello again. As some of you might remember, I stopped tx after 8 weeks due to retinal vascular occlusion in both eyes. At the time my WBC was very low and I was on Neupogen. I was undetected at 8 weeks, but the virus is back now. I chose not to have a biopsy before starting tx since I had such a bad after the last one 7 years ago (stage 0 to 1, mild periportal fibrosis). My platelets started to be in the 100K or lower, about 2 years ago and I had truble bleeding badly during the procedure for dental implants. I never had any symptoms, other than occasional fatigue, since I was diagnosed 16 years ago. I did pay myself for a FIBROSPECT test that showed 98% chance of being between F2 and F4 Metavir scale. My Dr. doesn

[TnHepGuy_]

Have you shown your doctor <a href="http://www.natap.org/2003/AASLD/day7_1.htm">this pilot study</a> on usage of Vioxx to raise/maintain platelet levels in combo tx patients?

It could possibly be a consideration for you now, even though you are not on tx, to see if it could help raise your platelets.

There have been reports of 1% of people taking Vioxx having a heart-realted concern as a result. And there are conflicting reports on Vioxx and gastric concerns. So these need to be discussed if you do bring the study to your doctor's attention.


May God's blessings and mercy be upon you.


TnHepGuy

http://www.natap.org/2003/AASLD/day7_1.htm

[Daria2]

Thanks for answering. My Dr. knew about Vioxx from same seminars in L.A., but sad that it was not a large study to justify adding new medication to be processed by the liver. I showed him a copy and he explained to me that he looks at a lot of factors that identify how the test was performed (%, accuracy, # of patients)that translate in how reliable it is. The Fibrospect is good to identify phase 1, but it gave me a % for anywhere between 2 and 4 for my test. He did't think much of it, that's whay he wants the biopsy. Daria2