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Is Biopsy the only way?
Hello Friends,
Can anyone tell me if a biopsy is the only way to evaluate liver damage.  Are there any blood test or CT, MRI or other means of evaluating if there is any liver damage.  An ultrasound of my abdominal area showed no abnormalities.  Before undergoing a biopsy I would rather find out first if real damage is suspected.  I know that many doctors like to go straight to the biopsy.  So far I have no symptoms and this is the first time my blood work shows slightly elevated emzymes.  Thanks for helping.
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446474 tn?1446351282
The liver biopsy is an important diagnostic tool because it is considered the most precise procedure we have today for evaluating the health of the liver by measuring the degree of liver inflammation and staging of fibrosis for
predicting disease progression and treatment outcome. Liver biopsy is "the gold standard" for staging liver disease.

The liver biopsy involves taking a very small specimen of liver tissue. The specimen is usually sent to a pathologist for evaluation. It is very important that this procedure and all lab tests are interpreted by a medical provider.
With this in mind, the information below is provided to help people understand the grading and staging of a biopsy.

Grading and Staging

There are a variety of ways to interpret a liver biopsy. The most common scoring methods include Metavir. It is important to remember that the length of the liver specimen and the knowledge of the professional reading the biopsy can influence the interpretation of the report.

Metavir

The Metavir scoring system was specially designed for patients with hepatitis C. The scoring consists of using a grading and a staging system. The grade gives an indication of the activity or amount of inflammation and the stage represents the amount of fibrosis or scarring.

The grade is assigned a number based on the degree of inflammation, which is usually scored from 0-4 with 0 being no activity and 3 or 4 considered severe activity. The amount of inflammation is important because it is considered a precursor to fibrosis.

The fibrosis score is also assigned a number from 0-4:
• 0 = no scarring
• 1 = minimal scarring
• 2 = scarring has occurred and extends outside
the areas in the liver that contains blood vessels
• 3=bridging fibrosis is spreading and
connecting to other areas that contain fibrosis
• 4=cirrhosis or advanced scarring of the liver

Information about the grade and stage of liver disease is helpful for the healthcare provider and the patient in guiding medical management. For example, treatment is usually indicated if the Metavir score is greater than or equal to 2 or the Ishak/Knodell score is greater than or equal to 3. It
is important to know this information in order to help guide management and treatment of HCV. For example, if a medical provider is able to estimate the approximate time when someone became infected with HCV, the results of the biopsy will give an indication of the rate of disease progression:

• For people with moderate to severe liver damage it is generally recommended that a more aggressive treatment approach is warranted.
• For people with a milder form of liver disease a watch and wait approach is usually recommended.
However, given that people with milder liver disease respond better to current HCV therapies some experts believe that people with milder forms of HCV liver disease should be treated.

Sound confusing? Probably the best advice is to work closely with your gastroenterologist or hepatologist to find out whether treatment is needed or not!

"Are there any blood test or CT, MRI or other means of evaluating if there is any liver damage."
Generally no. There is a Fibroscan available in a few places in the US but it is not easy to fond and not always accurately interrupted.

"Before undergoing a biopsy I would rather find out first if real damage is suspected. "
You are putting the cart before the horse. The biopsy is done to find out whether treatment is needed or not!
Most people chronically infected with hepatitis C have no symptoms.


Good luck.
Hector
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446474 tn?1446351282
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2toes,
Your question has already been correctly answered by Hector, who is the most knowledgeable and experienced person in this community.  However I see that you are a new member, so for your personal benefit I will add;
This is correct.  No other test is as reliable as the biopsy.
My ultrasounds have ALL been negative, showing normal liver - however subsequent biopsy showed extensive scarring (fibrosis).
FibroSure tests are normally reliable ONLY for very low and very high scores....to confirm respectively the absence or presence of significant fibrosis.  However most people taking FibroSure blood test will score within the middle ranges...which are notoriously UNRELIABLE, so for them it was a waste of time and money.
Suggest that you fully discuss all such questions and concerns with your hepatologist...and follow his or her recommendation.
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I appreciate all the information that you guys have given me.  Seems like the biopsy is the way to go.  Is there any way for me to tell how knowledgeable a doctor is about this disease?  I'm not easily forthcoming with trust when it comes to doctors ordering costly test that they perform themselves.
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its usaully radiologist OR radiologist'p.a. that performs biopsies.it really depends on where you go.thats what hospital told me friday when i had mine done.
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mine didnt hurt just for about 30 minutes and that was it and then i walked out of hospital no wheelchair,i hope this helps w/ yr fears.
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1840891 tn?1431551393
I'm glad you've been convinced of the biopsy, as everyone is right about the ultrasounds not being good enough. Mine were showing a normal liver right up to 6 months before a biopsy showed stage 4 fibrosis, also know as cirrhosis. I think the main thing is to have a really good hepatologist managing your care, preferably one at a large hospital with a liver clinic or liver transplant center, then take their recommendations as to who performs the biopsy. The results will be sent to a pathologist to be analyzed, so the doctor taking the biopsy will not be the one analyzing it. Good luck!
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I want to express my sincere thanks to all that shared this vital information with me.  With your help I know that I can get through this and that there are others so I'm not alone.  Yesterday I saw an opthamologist for the eye consultation and examination.  Now there is just the decission to treat or not to treat now, or wait til later.
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welcome to the forum, and indeed with this community you will never be alone you can get through this and i know its very scarey at the start but you will get fantastic advice and support from here promise! Good luck and keep us posted when you decide what to do
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I have a question about biopsy as well. I am scheduled for June 5 and have one day to rest before I have to get back to work on June 7. I own a Bed and Breakfast and am also a massage therapist. I don't have to do any heavy lifting and doing massage isn't all that strenuous really but I just want to be sure that this is a reasonable plan. I'm going into the busy season so there really isn't a better time to schedule until September
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85962 tn?1329984690
I've had two biopsy's ten years apart and they were virtually the same,  I think the next time I would opt for a ultra sound, But then again I have gone through this twice with mild (No. 1) results.
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i wait tables 6 days a week,i asked radiologist about working the very next day,he asked what i did and i told him what i did for a living i told him,he said IF i had a deskjob then-YES-i could work BUT any serious manual labor he didnt reccommend me working,MY BIOPSY was on a friday the 11th of MAY,i took off work where there's only me and another girl ,we wash our own dishes,didnt work SATURDAY AFTER and restaurant is closed on SUNDAYS ,i felt very fine on saturday and sunday but i strongly recommend taking off work the next day and being careful when you do work,radiologist said for me to not lift anything heavy for a couple of days,mine did hurt bad for about 30 minutes,they made me stay for 2 hours and i am also a CNA and i felt fine enough to take my own I.V. out and dress self BUT I  had to have a driver,you cant drive to hospital yrself.but the pain just vanished felt kind of sore that night ,laid around ALL the next day.i have had 4 surgeries since NOV.14,2011 THIS IS THE 1ST time that doc told me it wouldnt hurt and it didnt,i told her she was 1st doc that said it wouldnt hurt and it didnt.but i guess everybody is different but just letting you know how mine went.
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THANK YOU SO MUCH FOR ACCURATELY DESCRIBING THIS PROCEDURE YOU HAVE HELPED ME IMMENSELY BY DESCRIBING THIS SO GOOD-THANK U-WENDY
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