Biopsy Reading

I have hep C and I am genotype 1.  Recently I had a biopsy done and it shows I have Grade 4 Stage 2.  I think it means for inflamation (inflammation) I have a grade 4 which is the highest (inflamation (inflammation) in all the liver)and Stage 2 which is fibrosis.  I also have necrosis with bridging something like that.  I also did a upper endoscopy and they found traces of varices.  So they said I have some cirrosis (cirrhosis) because of this result.  That is what my wife explained to me that this means but since the doctor said we were wondering if we read it wrong that the Grade 4 meant the fibrosis and stage 2 meant for inflamtion.
Does any one know. I just dont know which comes first in readings.

I have read other answers on the forum and I know that they grade each on a scale from 1-4 but I was trying to understand a little more.

Thanks guys.
blong

[madbyron]

You are correct in your interpretation re: grading = degree of inflammation and staging = degree of fibrosis. But there are a number of scales used to quantify biopsy findings so it can be confusing. While checking several I did not find one that includes the presence of bridging necrosis in its stage 2 definition. That does not mean there isn't one. There are others in this forum that can better address whether or not evidence of varices may be present without advanced fibrosis/cirrhosis. But based on your comments, it does seem possible that the grading/staging scales were mixed up in communication. If I were you, I would speak with my doctor directly to clear up any confusion. Good luck. --MAD

[Indiana]

It all depends on the "scale" they are using. Look REAL closely at your results to figure that part out.
Here are all the sites I have on biopsy scoring. Read through them and compare and you should be able to decipher your results.

http://hepatitis-central.com/hcv/liver/scoring.html
http://hepcvets.com/cirrhosis/score/alltables.html
http://www.medhelp.org/forums/hepatitis/archive/478.html
http://www.hepatitiscaware.org/biopsy.html
http://curly.cis.unf.edu/lab.html
http://www.hepnet.com/liver/biopsy.html
http://tpis.upmc.edu/tpis/schema/mHAI.html

Let us know how you come out. Just DON"T panic! Things are the way they are. We all deal with our results the way they are. If you are really a stage 4 you need to get on top of this right away. I wonder if you are experiencing any symptoms yet? I would imagine so.
I hope those sites help you out...........

[GreatBird]

I would recommend getting a copy of the writeup. In fact, its a good idea to have copies of all your test results. I keep them in a file called "My Liver". I even have a little chart that I use to compare my numbers from blood draw to blood draw.

[willing]

here's an <a href="http://hepatology2.aasldjournals.org/scripts/om.dll/serve?article=ajhep0360s47&nav=full#R0360S47009"> article</a>  I found useful in understanding the three most common scoring scales: Knodell/HAI, modified HAI and Metavir. However, as madbyron notes, none of these include bridging at stage 2 so your pathologist may be using another scale. Getting a copy of the pathologist's report is definitely an important part of understanding your status. The pathologist is the one that renders the expert opinion about the histology of the biopsy slides and it's woth seeing what he had to say "first hand"