Biopsy interval

Yeah, I know, I asked this question already, probably around ten times. So what can I say? My memory is shot. Y'all know that, and you kind and forgiving medhelpers will bear with me, right? So here goes...

I had a biopsy in May 2008, for whatever it was worth (not much), and now, hardly more than two years later, THEY (T-h-e-M-e-d-i-c-a-l-A-u-t-h-o-r-i-t-i-e-s, aka pill-pushers, saw-bones, and various and sundry other licensed health-pork receivers and bent-by-bucks AMA toadies) want me to have ANOTHER ONE!!! (Okay, I'm gonna keep calm, everything's copasetic, I've still got some valium left, I'm breathing deeply, in, out, in, out...)

Is there any point to this second biopsy so soon? Does anyone know? I mean, I had three pathologies on the first one and they gave it, respectively, F1, F1/F2, and F2, so what info are they gonna get out of another one right away?

After the Fibroscan disaster (F3 at my hospital, F1/F2 at a respected private lab), and what with all the recent stuff about HCV-induced liver fibrosis NOT being homogeneous, is there ANYTHING to be gained from another biopsy now?

I gotta go into my hospital next week and deal with these...uh...these... (my knees are twitching, I just spilled coffee all over the table here in the local ciber cafe, the waitresses are starting to get that "get-him-outta-here" frown on their faces)...

Put the needle in my liver, see what you pull out; put the needle into me and see if I will shout...

It's all for the good of science, my son. Gee, Pop, go ahead and stick it to me, what's another percutaneous liver biopsy between buddies, right?

Or should I tell em where they can stick it?

M.

[Bill1954]

Mike, my personal experience as well as anecdotal reports from others in the forum tell us that a biopsy might be a good idea every 3-5 years for patients that are either refractory to treatment or are otherwise unable to undergo therapy.

As you’re (probably acutely :o)) aware it’s an invasive procedure with a slight risk for complications; still, I’d be wary of doing it unless I was going to use the information wisely somehow. I sure wouldn’t undergo biopsy to satisfy personal curiosity, for instance; but if it led to better management techniques somehow, um…that’s a different story.

You probably understand all this already, but maybe others will benefit from the topic.

Good luck with whatever path you choose--

--Bill

[Trish77]

They want you to have another one for what reason?  Just simply to keep tabs on  you or for some other reason?   If to keep tabs on you, I'd hold off only because you seem to be always dancing around treatment and investigating options.  One of those options might clearly need a current biopsy and then you'd be doing it AGAIN and you're skittish of the darn things, so why put yourself through that.  Having said that, I'd do one at 3 yrs thereabouts simply to keep tabs.  You're older, you've had this awhile and I'd just keep a closer eye on it as you move further into your Hep C-carrying years.  That's my two cents (or less) worth.

[Cory255]

Why do they want you to get a biopsy?  My Doc wouldn't allow a biopsy unless I was wanting to treat right then and there.  That doesn't make sense to me.  I thought that you should get a biopsy to see if you've got liver damage and if you do then you should undergo treatment before cirrosis (cirrhosis) or other liver complications occur.  

[portann]

Yeah, tell 'em where they can stick it but not in your liver for at least another year.

[djbn13]

My Doc doesn't lean towards biopsys either.  But since my insurance doesn't cover them and they are rather expensive it isn't really an option anyway.
Good luck

[Trinity4]

I will have another biopsy this fall.  It will be 3 years since the last one.  With stage 3/4 I have to know and with any luck the PI's will be out next year and I won't need another biopsy when I start treatment again.  

I hoping these licensed health-pork receivers and bent-by-bucks AMA toadies will save my life with the new drugs and if that doesn't happen I'll gladly come under their mercy to get a new liver.  These are the guys that are going save my a-s-s one way or another so I don't harbor the animosity towards the medical field like you do Mike.

Trinity

[frijole]

I have had 2 biopsies 3 years apart.  One before treating and one after relapsing.  My liver is in about the same state as yours -- that is , if you are a 1, 1-2.  I will probably request a biopsy in 2011 which will be 3 years again. However, my hepatologist did not seem to think I need one that often.  I cannot imagine why your team of doctors is requesting one now, but think I would hold off unless you can think of something that indicates more damage (higher enzymes, perhaps?)  Trinity has a good point about trials and treating too.  You have to have had a biopsy within a certain timeframe for trials or they will make you do another one so why not skip this one.

Hang in there and hold your ground.
frjiole

[spectda]

Hi Mike-
All the hepatologist I have seen (there are several) suggested biopsies every 3-5 years. I am planning on getting one after three mor years if I am sucessful with tx or not. As you mentioned the results and interpretations are so inconsistent.

If my results from my three biopsies were correct (at diagnosis, 5 years after, 6 years after that) I moved 2.5 stages in 6 years or 2.5 stages in 11 years. The gold standard has flaws. I want to know how serious it is becoming or if svr if my liver is healing.

Good luck with your decision

[mike716]

Thanks very much, everyone, for the helpful comments. I think my hep MDs want another biopsy because they are unsure about how fast my fibrosis is progressing.

Probably the best argument against doing another one so soon is the one about having to have a biopsy within one year of starting a trial, and since the PIs are supposed to be approved in 2011, it certainly makes sense to hold off for a while yet.

I think I´ll use that argument next week when go in, and just put my foot down and say I´m gonna wait until three years have elapsed.

My hospital here in Buenos Aires, unlike ones in the States, is free and footloose with the tests and analyses. They seem to feel that testing patients takes the place of treating them. And since they don´t have the foggiest idea whether or not to treat me, or with what, they are throwing tests at me all the time. I´m kinda fed up with going there and missing gym and other activities that at least do me some good. And instead of clearing things up, the darn test results just confuse the issues more and more.

There´s a question that I forgot to ask. Maybe I´ll put it into another thread, but here it is: Which is better, a needle biopsy or a laparoscopic biopsy?

A hepatologist I saw in February, who works at an up-scale private hospital out of town, said I ought to do a laparoscopic biopsy next because it gives specimens from various parts of the liver. However, when I mentioned this to a hep MD at my hospital, she said that the laparoscopic biopsy only takes material from the surface of the liver, whereas the needle biopsy gets inside and therefore is better.

I wonder which of them is right. Does anyone here know anything about this?

Thanks again for all the help. Don´t know what I would do without you folks.

Mike