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Best area of liver for biopsy
Hi all. I am wondering if anybody has any insight into what area of the liver a biopsy is most likely to show fibrosis or would be able to confirm portal hypertension? I had a biopsy previusly which indicated non-specific inflammation and no fibrosis, but I am having some most definite issues. My Dr. ordered anotyer biopsy as he said the first biopsy did not include enough liver tissue to be diagnostic, so I'm going back in for another one on Wednesday.
By the way, I am HCV negative, so it is from some other cause. I'm just wondering if there is a lobe or area in the liver which is more likely to suffer disease and cause symptoms or show something on biopsy over any other area? Are there areas of the liver which if injured produce more metabolic disturbance or liver congestion over other areas. For example, if somebody is symptomatic would there be a higher likely hood of injury being closer the portal veins or farther away from the main portal veins? Just wondering if anybody has any thoughts on the best liver location to Biopsy for the most telling results. There is a chance that I have a focal injury, but no tests have found anything yet. Thanks.
By the way, I am HCV negative, so it is from some other cause. I'm just wondering if there is a lobe or area in the liver which is more likely to suffer disease and cause symptoms or show something on biopsy over any other area? Are there areas of the liver which if injured produce more metabolic disturbance or liver congestion over other areas. For example, if somebody is symptomatic would there be a higher likely hood of injury being closer the portal veins or farther away from the main portal veins? Just wondering if anybody has any thoughts on the best liver location to Biopsy for the most telling results. There is a chance that I have a focal injury, but no tests have found anything yet. Thanks.
a/k/a Saliier .... I wanted to take the time once again to thank you for taking your time to be here. Also, thank you for a little bit of your background, which is really not necessary as you are not claiming to treat anyone here, nor are you diagnosing and administering prescriptions. I believe no one is obligated to give their 'credentials' or any personal background, or at least that is the way I understand it, and of course I'm new and don't know the ropes thoroughly. If someone comes on as a lab tech, nurse, doc, psychologist, researcher, etc... to give a personal take, or an opinion, the better for the members here. We are all ADEQUATELY informed there are no doc affiliated with medhelp at this particular support site.... it is all over the place to read... There is also a section "Doctor Profiles"... This is patient-to-patient; for families of friends of those with this virus. You're obviously a concerned party and a very knowledgeable one at that... and I already consider you a friend...
Again, WELCOME... by the way, my name is Libby...
Again, WELCOME... by the way, my name is Libby...
Actually, I am and have been involved with HCV research since the virus was discovered by the Chiron group, pretty much. As to my credentials, as I am not offering to treat anyone in the forum that is pretty much irrelevant.
As with all information here, folk should verify what they read elsewhere and consult with their own Doc before they act on anything. While I believe my medical opinions are pretty well "mainstream" (for example, my stance on liver biopsies is essentially that suggested by the NIH consensus on the subject published a few years back
As with all information here, folk should verify what they read elsewhere and consult with their own Doc before they act on anything. While I believe my medical opinions are pretty well "mainstream" (for example, my stance on liver biopsies is essentially that suggested by the NIH consensus on the subject published a few years back
Thanks for the inputs. I will ask the radiologist to take their time and find the best place for getting 2+ cm biopsy specimen. The last one I had was less than half a centimeter (5 milimeters), so it was never able to define what the "non-specific inflammation" was. I assume with a larger biopsy, the pathologist will be able to see what the "specific" cause of inflammation. My greatest area of discomfort tends to be just to the right of the sternum where the rib cage meets it, I;ll ask the radiologist to see if that is a logical place to biopsy, or perhaps it is too close to the main portal veins or bile ducts. We'll see.
since no one really asked i will, are you in fact a doctor? i have to admit i have some doubts. i agree with jim that i have never heard of a doctor that would perform a BX on someone "while on treatment" with interferon & ribavirin. i would love to hear your reasoning on this? regardless of wheather you are a MD or not welcome.
And for the sampling of 3 areas of liver for the best BX, i may be wrong but even an MD by the name of HR who use to visit here commented on this being the best procedure. i know one thing for sure, a single sample from a bx is NOT the "gold standard" and i would not trust it by itself !! now add a fibrosure & fibroscan tests along with it and that complete picture would be what i would trust.
And for the sampling of 3 areas of liver for the best BX, i may be wrong but even an MD by the name of HR who use to visit here commented on this being the best procedure. i know one thing for sure, a single sample from a bx is NOT the "gold standard" and i would not trust it by itself !! now add a fibrosure & fibroscan tests along with it and that complete picture would be what i would trust.
You may be right on what "HR" said -- don't remember -- but it may have been more in a research/theoretical sense, as opposed to a clinical resommendation. As stated above, needle biopsy is not without risk and three sticks no doubt increases that risk for what the article I posted above may not be that much -- if any -- more information.
As to "Saliier's" credentials, nothing he posted leads me to believe he isn't a doctor although the biopsy-during-treatment seems somewhat unorthodox, and remember, "HR's" credentials were also questioned in the beginning.
This is nott to say questioning someone's credentials on a predominatly patient-to-patient forum isn't appropriate -- it certainly is-- and hopefully Saliier will report back in a way that will both satisfy our concerns, as well as preserve any sense of privacy/anonymity he wants. As "Bill" stated earlier, it's always great to see a doctor or other type of medical professional take the time to visit us and offer their insights.
All the best,
-- Jim
As to "Saliier's" credentials, nothing he posted leads me to believe he isn't a doctor although the biopsy-during-treatment seems somewhat unorthodox, and remember, "HR's" credentials were also questioned in the beginning.
This is nott to say questioning someone's credentials on a predominatly patient-to-patient forum isn't appropriate -- it certainly is-- and hopefully Saliier will report back in a way that will both satisfy our concerns, as well as preserve any sense of privacy/anonymity he wants. As "Bill" stated earlier, it's always great to see a doctor or other type of medical professional take the time to visit us and offer their insights.
All the best,
-- Jim
Actually, the reaason why we use ultrasound when taking biopsies is proimarily to ensure we hit the liver and not, for example, the gall bladder colon or lung. Ultrasound does not help localise the "best" area of the liver to take a biopsy from.
I hope this helps.
I hope this helps.
The vast majority of patients with Hep C can be adequately and very effectively managed (meaning: treated) without a liver biopsy.
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I assume then that unless medically contraindicated you fall into the "treat practically all cases of Hepatitis C" medical camp? Because if you believe in "watch and wait" (until a certain level of liver damage is present) then a needle biopsy (or perhaps Fibroscan) seems prudent to determine stage and then follow-up biopsies at 3-5 year intervals to monitor.
The other reason for biopsy would be to guide both doctor and patient on what you term "continuation of treatment" decisions if the patient is having problems during treatment -- i.e. if little or no liver damage, maybe stop; significant liver damage, maybe dig in and continue.
You appear to address this issue with the what at least to me appears to be the unorthodox approach of biopsy *during* treatment. My layman's question is doesn't a biopsy during treatment carry additional risks due to a lower platelet count, etc? And if not, why don't we hear more about during treatment biopsies which I don't believe have been reported here for example.
Lastly, what is your take on the new "Fibroscan" device? I've heard favorable reports both from my hepatologist as well as others. On a personal note, I had a Fibroscan six months into treatment and six months following treatment.
As "Bill1954" said, welcome to the discussion group and it's always great when MDs or other medical professionals stop by with their unique and educated perspective.
-- Jim
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I assume then that unless medically contraindicated you fall into the "treat practically all cases of Hepatitis C" medical camp? Because if you believe in "watch and wait" (until a certain level of liver damage is present) then a needle biopsy (or perhaps Fibroscan) seems prudent to determine stage and then follow-up biopsies at 3-5 year intervals to monitor.
The other reason for biopsy would be to guide both doctor and patient on what you term "continuation of treatment" decisions if the patient is having problems during treatment -- i.e. if little or no liver damage, maybe stop; significant liver damage, maybe dig in and continue.
You appear to address this issue with the what at least to me appears to be the unorthodox approach of biopsy *during* treatment. My layman's question is doesn't a biopsy during treatment carry additional risks due to a lower platelet count, etc? And if not, why don't we hear more about during treatment biopsies which I don't believe have been reported here for example.
Lastly, what is your take on the new "Fibroscan" device? I've heard favorable reports both from my hepatologist as well as others. On a personal note, I had a Fibroscan six months into treatment and six months following treatment.
As "Bill1954" said, welcome to the discussion group and it's always great when MDs or other medical professionals stop by with their unique and educated perspective.
-- Jim
just wanted to chime in and say thanks for coming by. fairly new here... but sure appreciate a dr stopping in. please come by often...
Just like to add that needle biopsy is an invasive procedure and not without risk, and I would think that taking mutiple samples from different parts of the liver would add to that risk.
Also, the following article (free Medcscape registration required) suggests that that these multiple samples may not be important for accurate staging. Far more important would be sample size, including the number of portal tracts within the sample. http://www.medscape.com/viewarticle/474410_4s
Certainly liver biopsy may not live up to its suggested moniker of perfection, i.e. the "gold standard", however short of removing the entire liver for examination, the single biopsy sample seems more than adequate in most cases that require a biopsy.
-- Jim
Also, the following article (free Medcscape registration required) suggests that that these multiple samples may not be important for accurate staging. Far more important would be sample size, including the number of portal tracts within the sample. http://www.medscape.com/viewarticle/474410_4s
Certainly liver biopsy may not live up to its suggested moniker of perfection, i.e. the "gold standard", however short of removing the entire liver for examination, the single biopsy sample seems more than adequate in most cases that require a biopsy.
-- Jim
I think that what part of the liver that is biopsied and the number of samples really depends on each individual case. That is why biopsies of usually of 90-100% of the time performed with an ultrasound, thus ultrasound-guided liver biopsy. I've had 4 of them over the course of the years. Most of the time, they have not taken numerous samples, but all of the time on me, it is been ultrasound guided. This is how they determine where the best place to take the sample is.
Susan
Susan
The vast majority of patients with Hep C can be adequately and very effectively managed (meaning: treated) without a liver biopsy. I never do one unless there are some complicating issues such as a high probability of alternative or complicating co-existing liver diseases (eg HBV, autoimmune liver disease ect etc), or the individual is having difficulty with the treatment (then the question the liver biopsy addresses is whether or not continuation oftreatment is actually imperative). As to multiple biopsies from different areas of the liver, while this may be the councl of perfection for research purposes, it also increases the risk to the patient significantly and I don't know of any clinician who would do this. It is certainly important that the biopsies are of adequate length (about 2 cm is good) and does not contain the liver capsule (biopsing the capsul probably increases the risk of haemorrhage and makes interpretation of fibrosis etc more problematic if the biopsy sample is small.
thats a great question...i know nothing about ... would like to hear comments since i will most likely be getting a biopsy soon...thanks...billy
Copyman is right on regarding the biopsy samples and sizes, those factors are key to a "good" biopsy sample. I'd ask the doctor if those are the biopsy sample guidelines he plans to use so you will have the best possible assessment of your liver condition.
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