Biopsy Intel

[bflower]

Thanks again, all for your responses. This is really meaningful to someone like me.

My gyno (whom is the surgeon that discovered my HCV status) just recently said that where Biopsies were
once status quo for HCV it is now contraindicated as harmful. Any truth to that? Does anyone have any new knowledge on this? I have not had a liver biopsy (uterus yes, but nothing like liver by comparison), and I am very trepidatious.
Thanks in advance to any response.

PS I have just successfully acquired full med bennies and have a standing appt with a GP who will refer me to a GI and I will go from there. Wish me luck!
Best to all.

[eureka254]

Yes, you hit it on the nose.  It was great for folks who didn't have hcc to have the biopsy confirm the absence of malignancy, but for those with hcc, retrospective analysis actually showed that a majority of those hcc's confirmed via tumor biopsy had the lowest survival rates (post-biopsy status was reversely proportionate to eventual eligibility for resection or tp...).

[IAmTheWalrus]

Eureka,

"..........it has indeed been found to be dangerous and is now contraindicated in hcc."

Is that because of the danger of "track seeding" of the cancer cells?

Brent

[eureka254]

As stated above, it's actually fairly common after diagnosis of hcv to have liver biopsy to assess the amount of liver tissue damage.  However, it may be possible that what your gyn is referring to is the old practice of doing biopsy on hcc (which is a cancer caused by hcv), which in recent years has been deemed as doing more harm than good.  For many years, when hcc was suspected, a tumor biopsy would be done, just like for other cancers, but it has indeed been found to be dangerous and is now contraindicated in hcc.  But this caution applies strictly to biopsy of liver cancer, and not to biopsy of normal liver tissue.  Hope that helps, and best of luck! ~eureka

[IAmTheWalrus]

Another study of biospy complications from nih that shows a similar risk:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1856755/

I have had a total of 6 biopsies. Three were pre-transplant and three have been post-transplant. Incidentally, the risk of bleeding from biopsy procedure in a transplant patient is much less than for others due to the large amount of scar tissue around the liver.

[IAmTheWalrus]

All medical procedures and medicines carry risks. Biopsies are certainly no exception. As Bill said, if the result will not influence the treatment course, it is not necessary or worth the risk to order one.

I think the major risk in biopsies is internal bleeding. Major problems with this occur in about 1 in 500 patients with death in about 1 in 1,000 according to some studies. This includes some high risk patients. If you do not fall into one of these higher risk groups, your likelihood of complication goes down (or up, if you are in a high risk category).

One study concludes that a longer observation time needs to be adhered to. In this study of nearly 3,000 patients, there were 12 (.32%) incidents of major complication, none fatal.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1942123/

The authors claim this rate is comparable to other studies done on the issue.

[bflower]

thank you. Im trying to take milk thistle and echineaca however Im finding the higher quality brands are usually suspened in grain alcohol. does this worry everyone as much as me??

[Diane12855]

I agree with Bill. All of your decisions need to be based on info your receive from a liver specialist, not a female specialist.

Just my opinion.

Diane

[Bill1954]

I think once you get your referral to a GI or hepatologist, they’ll give you more exacting info; it’s hard for a GYN to stay on top of liver stuff, I’d imagine.

No, liver biopsies are still performed for HCV patients, although there are good reasons for and against. It is an invasive procedure, and unless it is used for decision power, it’s probably not a good idea to get one. Complications are a rare, but real issue.

Say, for instance that you intended to undergo treatment, regardless of biopsy results; in that instance, a biopsy wouldn’t be of much use. If you are successful with treatment, and assuming you don’t have cirrhosis, any existing liver damage will not worsen, and in some cases would be expected to improve.

Additionally, if you are genotype 2 or 3, the high rate of success might not warrant biopsy risk; if treated, you will likely go on to sustained response, and liver damage won’t be an issue.

Basically, liver biopsy is a good tool to determine urgency for treatment; if you intend to postpone/delay therapy, biopsy results can guide you in that regard. If you plan on treating anyway, it might not be required.

If you like, you can respond to your own posts by clicking on the green ‘post comment’ button at the bottom of this page; it will help keep your thoughts in one place, rather than starting a new thread each time.

Good luck—

Bill

[FlGuy]

A biopsy will likely continue to be the most important element for diagnosing and treatment decisions, at least for genos 1 and 4 for a while.  But, in the coming years I would not be suprised to see that change for a combination of reasons;  approval and wider use of Fibroscan or something very similar, the use of new PI's - especially if they cut treatment time in half and imporve cure rates,  a full rollout of Healthcare Changes which might necessitate less frequent use of expensive testing methods.