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Fibrosis testing
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Fibrosis testing

Does anyone know how accurate the new blood test for fibrosis is? Has problems with the peg treatment 3-4 yrs back,but my doc at that time said (because of a biopsy) that I was still and good shape and that we would run a new biopsy this yr. I have since got a new doc and he ran the blood test,and is suggesting I start treatment again. I'm hesitant because last time I came within an hour or 2 of dying from the treatment. How does the blood test compare to a biopsy in accuracy. I realize the there are risks but so is the treatment.
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87972_tn?1322664839
Hi,

Are you referring to Fibrospect or Fibrosure? I believe these blood tests are more accurate towards the ends of the scale; for instance, they are better at determining stage F0 and F4, but don’t accurately discern between say, stage 1 and stage 3.

How long ago was your last needle biopsy; did the new doctor prefer blood surrogate testing over liver biopsy, and why?

Sorry to hear the last treatment was so difficult for you; what sort of problems did you experience? It’s possible to address many of the interferon side effects using proper medications.

Good luck-

Bill
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789911_tn?1368640383
Hi, I have not yet had a biopsy and was dx in 2009.  I have had 4 blood fibrosis tests done.  Hepascore by Quest Diagnostics in April 2009 came back F0-F1   Had a second test done in August 2010  came back F0-F1.  Had a Fibrosure Test by Lab Corp done March 2011 came back F4-Cirrhosis!  I am waiting on results from a fourth test Hepascore by Quest Diag.  for a 2nd opinion  to compare to the Fibrosure.  Should know the results any day and will post when I get the results.  Someone asked me why so many tests? Well, since none of it is an exact science, it is much easier to have multiple blood tests than biopsies.  I figured one every 6 months to a year while waiting for the new drugs to come out since I am IL28B gene CT.  REally need that 3 drug cocktail for more chance of success.  
Needless to say when I got back the F4-Cirrohsis result from Fibrosure I was dismayed.  I am hoping it is incorrect.  
A lot of people don't like the blood tests and only rely on the biopsy.   I can understand why because of my own experience at this point.  I was relying heavily on the blood tests.
   All of it makes me uneasy due to the fact the margin of error in all the tests, plus everyone progresses with HCV at different rates, even though overall fibrosis progression is slow moving, unless you are one of those who progresses quickly.  If you only have a biopsy every 3 years, alot can happen in three years for some people.  I now feel you should really do both as you watchful wait to treat.  I might have not come back for another bloodtest for another year or two according to my doctor after the first Hepascore test.  Then where would I be.  Now if the F4- Cirrhosis is the true accurate state of my liver, I am now ineligible for  most trials and will be harder to treat.  If I had it to do over, I would have ditched my fears of the biopsy, done both biopsy and blood test to compare, and had blood tests inbetween biopsies to keep an eye on anything changing.     Of course to do all this testing unless your rich, you better have some insurance.    
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Avatar_m_tn
Problems with last treatment is after 11 weeks my hemo count went down to 4 so my heart was, as the E.R. doc put it "pumping kool-aid". I really felt like crap the whole time and all I was told was to drink more water.I drank so much water I couldn't even drive to work with out have a restroom route mapped out. My new dr is suggesting lower doses of I guess the Riba and an additional drug. (still undertermined) also with an additional bone marrow stim. I'm 60 yrs old and feel in excellent health. I do not know what stage of fibrosis the blood test showed by I am leaning towards having another biop. just to be sure
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87972_tn?1322664839
I’m not sure, but if you’re using inaccurate measures it really doesn’t matter how many of them you get; a consensus is still faulty.

The gold standard for determining hepatic fibrosis is still liver biopsy; and yes, it’s imperfect. Other methods continue to be compared to it, rather than other techniques though.

It seems to me multiple testing using inferior techniques adds to confusion rather than removing it.

Bill

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Avatar_m_tn
Previously my reg doc was doing blood tests every 3months but my liver doc said results were so benign that he only wanted them done once a yr. Mind you these were just viral and enzyme count blood tests. I am glad you offered up doing a biop because that was my plan I also think I may do another blood test for fibrosis bicause as you say errors can happen. Thank you
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87972_tn?1322664839
Boy, if your hemoglobin had dropped to 4.0 g/dL you were pretty ill. I assume you received transfusions?

When you refer to ‘bone stims’ I assume you’re referring to Procrit (epoetin)?

There are new drugs pending FDA approval that will be added to the existing interferon/ribavirin to improve odds of success. These are ‘Telaprevir’ and ‘Boceprevir’.

In clinical trial, Boceprevir tended to exacerbate the treatment-induced anemia, while the Telaprevir didn’t affect it appreciably. When you speak with your doctor about choices, you might lean toward the Telaprevir. And of course, initiate Procrit at the first sign of trouble.

Good luck-

Bill
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Avatar_m_tn
Yeah I got 5 units of blood and bone marrow stim shots. Kept me in e.r. for 25 hrs. Had to get up and perform at a benefit for my lead guitar player who died of liver cancer 6months earlier. The show must go on.
Have an appt next month with dr. and will ask about new drugs. also about biop.
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446474_tn?1404424777
In my opinion blood tests to evaluate the degree of fibrosis is a waste of time and is causing more worrying then it is worth. As Bill said the current standard test for determining fibrosis of the liver is biopsy. It is a very low risk procedure. Only two to 3 percent of people have complications. If you have had blood drawn it isn't much more painful then that. What is much much worse is not knowing if you have cirrhosis and then reach the point when you can no longer be treated for hepatitis C. You will then need a transplant.

At most a repeat biopsy should be done every 2-3 years. There are only 4 stages of liver fibrosis. It usually takes 30-40 years to go through all stages so its there is a wide variation between the start of a stage and the end of a stage. But it give you a estimate of how damaged your liver is and that is what is important to know.

If your doctor follows best practices (and diagnoses the stage of fibrosis by biopsy) you will know what stage you are and this may help to determine if you need to do treatment now or wait for more effective treatments in the drug pipeline.

Good luck!
Hectorsf
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789911_tn?1368640383
Your  right...   As a new person being dx and trying to find my way,  When I was at the liver institute in Dallas they had no problem assessing me with a hepascore. Which apparently is faulty, and a sonogram, which is worthless some say.    
  I know I did say I didnt want a biopsy unless it was necessary.  They never said necessary.  They seemed perfectly content with the score and relating that to all my other blood work.  I want to talk with someone who is an expert on the reason they use the bio markers they use and how each result is incorporated into their scoring.  I tried to look it up on line without much sucess.  
  I think I saw in a prev post that your had a fibrosure test done results in the high 90's  which I think you said was inaccurate and Hector didnt you say you had several tests and they flucuated as much as two grades in a very short period of time?    
It would be nice if people who have had these tests would post their fibro-test scores and the biomarker test results that went into giving them their fibro score.    The more people who have had these tests done and the results posted would be a big help to many that are considering the test instead of biopsy so they can make an even more informed decision.  Heck, I didnt realize there was even a difference in the tests, hepa-score and Fibro-sure until here recently.   That's how informed i am.  
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87972_tn?1322664839
Hi again,

I had a Labcorp Fibrosure in December, 2007. The NP ordered it; it wasn’t something I requested. I was in treatment at the time, and had been for most of the previous two years. The manufacturer clearly recommends against this test for a number of reasons, including, “…Acute hemolosys (i.e., HCV ribavirin therapy mediated hemolosys…)”

I mentioned this to the nurse NP who insisted I take the test regardless. When I reviewed the results later with the doctor, he said they don’t apply ANY diagnostic weight to these blood tests anyway; they just didn’t trust the results.

As a result, my score returned as .92; cirrhosis begins >.74.

If the patient intends to treat regardless of pathology report, a very good case could be made to forego biopsy. It really doesn’t make much difference if the patient is at stage 1 or stage 3; if they treat successfully, we figure no more damage will occur, and perhaps even subside somewhat.

Using biochemical markers and exam, a good clinician can diagnose frank cirrhosis; so that can be ruled out without biopsy as well.

The biopsy is a pretty decent tool to use if the patient intends to postpone/delay therapy; it can suggest urgency and tell the patient when to dive into treatment. Other than that, there’s probably no real point in it; at least to my mind.

Good luck sorting all this out, by the way. Take care—

Bill
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