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Hepatitis C (Expert Forum)
Re: Biopsy Report
Questions posted in the Hepatitis C Forum are answered by medical professionals from The Mount Sinai Medical Center.
Re: Biopsy Report
by HFHSM.D.-D.M., Jan 01, 1995 12:00AM
Posted By HFHSM.D.-D.M. on April 16, 1999 at 15:26:21
Topic Area: Hepatitis C
I read the board for imformation about my biopsy results which showed Fibrosis 3+4. I'm on interferon and this is my 4th month. Doctor says since I'm responding I should stay on this for a year. Tell me please If I have this right....Part of my liver is bridging and part of my liver is scarred......Fibrosis 4 is just a nice way of saying cirrhosis. Would this mean little scarring or alot? The part that is scarred can't be fixed right? Were about to move into the country by a lake which means I'll be living 40 minutes from the hospital my insurance will pay for. So, from the sounds of my biopsy report should I have to fear something major to go bad with me,or should I take the leap???? Thanks you for any responce I might get. MaryS
Dear Mary S.:
I really appreciate your questions about your liver biopsy. The liver biopsy is one of the most important parts of the evaluation of someone with hepatitis C. It is critical that the biopsy be interpreted and explained properly.
Let me talk about the biopsy in general first and then Ill answer your specific questions. Fibrosis is scar tissue that forms as a result of persistent inflammation in the liver. If you cut your skin, you form scar tissue which is good. However, if you inflame the liver, you can develop scar tissue or fibrosis which can be bad. If the fibrosis advances, it can start to destroy the liver. Typically fibrosis starts around the portal tract and the mildest form of fibrosis is periportal. As the fibrosis extends, it typically extends kind of like spokes from the center of a wheel. The spokes are called fibrous septae. When the fibrous spokes from one wheel meet with the fibrous spokes form another wheel, they form a bridge and we call that bridging fibrosis. This is often called stage 3 by the Knodell classification of grading liver biopsies.
If the fibrosis advances beyond this, we call it cirrhosis or stage 4. Cirrhosis is the most advanced form of fibrosis and indicates there is substantial damage to the liver. However, a liver can still potentially function well with cirrhosis for many years. Patients with hepatitis C can especially do well for many years with cirrhosis. In fact, many of these patients are appropriate candidates for treatment.
Now let me answer your questions. Typically if a patient is responding to treatment, they should stay on treatment for a full year. If someone is on interferon alone, their physician might consider adding ribavirin because the combination is clearly superior to interferon alone. Your statement that part of my liver is bridging and part of my liver is scarred...... is not correct. Fibrosis and scare are the same thing. It is more likely that the extent of scarring throughout the liver is relatively uniform. Stage 4 fibrosis typically means cirrhosis and this does mean there is a lot of scar. Your statement that the scarred part of liver cant be fixed is also unclear. In fact, there is a lot of evidence that in any circumstances scarring can improve considerably. Finally, while I dont know all the details of your situation, I dont see any reason that you cant live 40 minutes from your hospital.
I hope this information is helpful to you. Good luck with your situation. I would invite you to contact us again with additional concerns or questions. At Henry Ford, we have an active group of liver specialists with a strong interest the care and research of with hepatitis C. You can contact us directly at (313) 916-8865.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.
Follow Ups:
Topic Area: Hepatitis C
I read the board for imformation about my biopsy results which showed Fibrosis 3+4. I'm on interferon and this is my 4th month. Doctor says since I'm responding I should stay on this for a year. Tell me please If I have this right....Part of my liver is bridging and part of my liver is scarred......Fibrosis 4 is just a nice way of saying cirrhosis. Would this mean little scarring or alot? The part that is scarred can't be fixed right? Were about to move into the country by a lake which means I'll be living 40 minutes from the hospital my insurance will pay for. So, from the sounds of my biopsy report should I have to fear something major to go bad with me,or should I take the leap???? Thanks you for any responce I might get. MaryS
Dear Mary S.:
I really appreciate your questions about your liver biopsy. The liver biopsy is one of the most important parts of the evaluation of someone with hepatitis C. It is critical that the biopsy be interpreted and explained properly.
Let me talk about the biopsy in general first and then Ill answer your specific questions. Fibrosis is scar tissue that forms as a result of persistent inflammation in the liver. If you cut your skin, you form scar tissue which is good. However, if you inflame the liver, you can develop scar tissue or fibrosis which can be bad. If the fibrosis advances, it can start to destroy the liver. Typically fibrosis starts around the portal tract and the mildest form of fibrosis is periportal. As the fibrosis extends, it typically extends kind of like spokes from the center of a wheel. The spokes are called fibrous septae. When the fibrous spokes from one wheel meet with the fibrous spokes form another wheel, they form a bridge and we call that bridging fibrosis. This is often called stage 3 by the Knodell classification of grading liver biopsies.
If the fibrosis advances beyond this, we call it cirrhosis or stage 4. Cirrhosis is the most advanced form of fibrosis and indicates there is substantial damage to the liver. However, a liver can still potentially function well with cirrhosis for many years. Patients with hepatitis C can especially do well for many years with cirrhosis. In fact, many of these patients are appropriate candidates for treatment.
Now let me answer your questions. Typically if a patient is responding to treatment, they should stay on treatment for a full year. If someone is on interferon alone, their physician might consider adding ribavirin because the combination is clearly superior to interferon alone. Your statement that part of my liver is bridging and part of my liver is scarred...... is not correct. Fibrosis and scare are the same thing. It is more likely that the extent of scarring throughout the liver is relatively uniform. Stage 4 fibrosis typically means cirrhosis and this does mean there is a lot of scar. Your statement that the scarred part of liver cant be fixed is also unclear. In fact, there is a lot of evidence that in any circumstances scarring can improve considerably. Finally, while I dont know all the details of your situation, I dont see any reason that you cant live 40 minutes from your hospital.
I hope this information is helpful to you. Good luck with your situation. I would invite you to contact us again with additional concerns or questions. At Henry Ford, we have an active group of liver specialists with a strong interest the care and research of with hepatitis C. You can contact us directly at (313) 916-8865.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.
Follow Ups:
