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Avatar universal

FibroSure and biopsy

Last summer or thereabouts, I had a Fibrosure test which indicated a score of F3 which was quite high compared to previous assessments of my liver.  My doc then decided we should do a liver biopsy which showed a fibrosis score of 0-1.  We decided to do another Fibrosure test 2 weeks ago which I discovered yesterday was F4 Cirrhosis.  Yikes.  Well, I did a little further digging and discovered that the Fibrosure test requires 10-12 hours of fasting ... no one had told me this and in both cases I had eaten regular meals.  Would digesting food skew the results so dramatically?
Because of this last test, my doc wants to start me on Telaprevir+PegIfn+Ribavirin.  Only prior treatments were with regular Interferon and Ribavirin.  I have the IL28B allele CC.  Should I go ahead and do the TPR treatment or wait for Sofosbuvir or do another Fibrosure test this time after fasting?
72 Responses
1654058 tn?1407162666
Not an expert, but there are some on here who will respond. I thought the biopsy was the most accurate assessment. What does your doctor say about that?
BTW - does anyone know for sure? Isn't fibroscan the one that is subjective according to the experience of the technician?
Your doctor should be able to give you more into. I'd ask more questions.
Best to ya! Karen:)
Avatar universal
It's also my understanding that the liver biopsy is the gold standard.  Did
you tell your doctor about eating before your fiberosure test? With results
as varied as that... I would be on the phone right now to your doctor telling
him/her you ate before the tests if this is the case.  Do you want to treat
24 weeks or 48 weeks?  Start by calling your doctor today.
4113881 tn?1415853876
I agree with crossroadsec about the biopsy being the most accurate. Also, I have read many who were diagnosed with different fibrosis scores with the biopsy being the correct reading. If your going to take the FibroSure serious, you need to retake it after having fasted if that's required IMO.

Heres some info I pulled on how inaccurate the Fibrosure test is:

1). HCV FibroSURE misclassified 39% of patients (26 of 66) with minimal-stage disease on biopsy (F0 = 12; F1 = 14) as false-positive F2-4 (F2 = 13; F3 = 7; F4 = 6). Of the 13 patients misclassified as F3 or 4 by HCV FibroSURE, 6 of 12 were F0, and 7 of 14 were F1 according to biopsy. FIBROSpect II misclassified 34% of patients (25/73) with F0-1 (F0 = 9; F1 = 16) as F2-4. None of the 18 patients with F2-4 according to biopsy were misclassified as false-negative F0-1 by HCV FibroSURE; 1 of 22 (4%) with F2 by biopsy was misclassified as F0-1 by FIBROSpect II. Of the 84 patients with both panel results available for analysis, 67 (80%) were classified correctly as F0-1 or F2-4 with relatively good agreement (κ = 0.60). For the 52 patients with biopsies ≥15 mm, both panels demonstrated excellent sensitivity (1.00 for both), with a trend for an improved AUROC with FIBROSpect II compared with that with HCV FibroSURE (0.94 vs 0.89; P = 0.40; Table 2 and Figure 2).

http://www.medscape.com/viewarticle/589349_3
4113881 tn?1415853876
I know its hard to ignore a test that says your stage 4...I would have a hard time ignoring it at least. Its one of those things where your just going to have to make a decision however I wish I remembered the username because there's someone on this site with the same issue...Fibrosure said stage 4....had a biopsy that said 1.  At the very least Id ask for a new Fibrosure under the proper fasting conditions.
766573 tn?1365170066
Can you post more about your health and how your other labs look.
The Fibrosure is only one possible indicator of cirrhosis. There are biochemical markers such as platelets, INR and the like - that may or may not be apparent. That your doctor would like to leap into treatment without more data is unsettling. I know if I were treatment naive and I had the CC IL28B allele I would at least ask about Victrelis. Did your doctor explain that the CC genotype is associated with better rapid virological response (RVR) and SVR?

I realize you are wondering if what you ate and when had an impact on your FibrosSure result but I guess I am seeing the situation with a considerably different view. Your doctor (ideally) should have been able to explain this. Is there a particular reason why you have had no other type of assessment of your liver function other than the FibroSure?

You are right though - this brochure about the Fibrosure says you should fast for 8 hours. There are lots and lots of threads on here related to the disparity of the FibroScan (FibroSure) and compare/contrast to a biopsy

In the PDF it says:
Discordance between liver biopsy and FibroTest/ ActiTest results
were primarily due to sampling errors associated with small biopsies 15 mm indicating greater concordance when biopsy sampling errors were reduced.

In a recent publication by Poynard et al, discordance of two or more stages between FibroTest and liver biopsy (n=154 discordant samples) was caused by errors in sampling or interpretation of the liver biopsy associated with biopsy size and steatosis more than 60% of the time (97/154) and to errors in the biochemical test in less than 10% of cases (13/154). The reason for the discordance could not be determined in 44/154 samples

http://www.fairfoundation.org/news_letter/2010/02june/Fibrosure..pdf


Here are a few threads:
http://www.medhelp.org/posts/Hepatitis-C/Fibroscan-vs-Biopsy/show/1800504

Bali has lot of insight
http://www.medhelp.org/personal_pages/user/979080
Avatar universal
This is something that needs to be figured out. What type of doctor are you seeing? Also so you know the fibroscan and fibrosure test are two completely different tests, fibrosure is done by drawing blood.

Being that you didn't fast before hand I wouldn't rely on that test. Also are there other signs of cirrhosis? a CBC should help decide that. The biopsy is the gold standard that Hepatologist rely on... Your talking about treating for 48 weeks instead of 24, I would sure want this cleared up soon.

Good luck
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