Aa
Follow up Fibroscan?
How reliable are the fibroscan scores, my partner finished treatment in August 2010 at that time his fibroscan score was 30 - now only 8 months later it is 20 ,,,,, he has another one in August and a MRI (its part of the post treatment care at the liver clinic here in Toronto) Does this not seem a little too good to be true? Any thoughts?
I need to amend my thoughts above:
“Bree, the risk for developing HCC doesn’t increase until the patient develops cirrhosis.”
I was at the liver clinic today for treatment follow up. I’ve been SVR now for a while; my last IFN was in August, 2008. I was stage 3-4 by liver biopsy in 2005; however, ultrasound back then indicated enlarged liver and spleen. There was (and is) some thought that I might have been transitional to cirrhosis at some point, so Dr. Liverbetter has been following me with biannual U/S scan and AFP marker.
I asked about the need for continued HCC surveillance; she said that long-term results from the HALT-C study found an increased incidence for stage 4, as well as some stage 3 patients. She was adamant that I should continue surveillance; that the risk justified the resources. When I pressed a bit and asked if this extended to all stage 3 patients, she said it’s left to the clinician’s discretion.
This jives with Willing’s thoughts above, but to note she made no mention of stage 2 fibrosis and HCC monitoring.
As always, discuss your concerns with a qualified medical professional-
--Bill
“Bree, the risk for developing HCC doesn’t increase until the patient develops cirrhosis.”
I was at the liver clinic today for treatment follow up. I’ve been SVR now for a while; my last IFN was in August, 2008. I was stage 3-4 by liver biopsy in 2005; however, ultrasound back then indicated enlarged liver and spleen. There was (and is) some thought that I might have been transitional to cirrhosis at some point, so Dr. Liverbetter has been following me with biannual U/S scan and AFP marker.
I asked about the need for continued HCC surveillance; she said that long-term results from the HALT-C study found an increased incidence for stage 4, as well as some stage 3 patients. She was adamant that I should continue surveillance; that the risk justified the resources. When I pressed a bit and asked if this extended to all stage 3 patients, she said it’s left to the clinician’s discretion.
This jives with Willing’s thoughts above, but to note she made no mention of stage 2 fibrosis and HCC monitoring.
As always, discuss your concerns with a qualified medical professional-
--Bill
here's a couple of refs regarding those questions:
from "Surveillance for hepatocellular carcinoma: in whom and how?" by El-Serag (one of the leading US HCC researchers) (free access)
http://www.ncbi.nlm.nih.gov/pubmed/21317990
>speaking of hcc scans, should everyone have hcc checks that have/had HCV, should that be a yearly or so check?
"The recommended interval between HCC surveillance tests is 6–12 months. This interval is based on the median doubling time of HCC, which is estimated to range between 80 and 117 days "
and
"HCC surveillance is not recommended in patients with HCV in the absence of cirrhosis. "
(though I recall another recent survey reporting increased incidence among F3 and even F2)
>how is that checked, through ultrasound?
"We recommend a combination of liver ultrasound and serum alpha fetoprotein (AFP). Liver ultrasound is recommended as the primary surveillance modality for HCC; it has a modest sensitivity of approximately 60% and a higher specificity of approximately 85–90% [Singal et al. 2009]. The performance of ultrasound as a surveillance test depends on the experience of the examiner." ( also see discussion of CT/MRI)
>And a 7 on fibroscan is about equal to what in a biopsy?
FS interpretation scales vary a lot in detail. Given that healthy livers come in with FS scores of 4-5
http://www.ncbi.nlm.nih.gov/pubmed/19929903
and at least F2 is likely above 9
http://www.ncbi.nlm.nih.gov/pubmed/19887952
I figured 7 was a good goal.
The actual number is the result of a complex statistical calculation involving the taste of the first sip of beer at the end of a long day, the difference between my life expectancy and current age, and insight into the cosmic game of craps, where 7 is a natural!
from "Surveillance for hepatocellular carcinoma: in whom and how?" by El-Serag (one of the leading US HCC researchers) (free access)
http://www.ncbi.nlm.nih.gov/pubmed/21317990
>speaking of hcc scans, should everyone have hcc checks that have/had HCV, should that be a yearly or so check?
"The recommended interval between HCC surveillance tests is 6–12 months. This interval is based on the median doubling time of HCC, which is estimated to range between 80 and 117 days "
and
"HCC surveillance is not recommended in patients with HCV in the absence of cirrhosis. "
(though I recall another recent survey reporting increased incidence among F3 and even F2)
>how is that checked, through ultrasound?
"We recommend a combination of liver ultrasound and serum alpha fetoprotein (AFP). Liver ultrasound is recommended as the primary surveillance modality for HCC; it has a modest sensitivity of approximately 60% and a higher specificity of approximately 85–90% [Singal et al. 2009]. The performance of ultrasound as a surveillance test depends on the experience of the examiner." ( also see discussion of CT/MRI)
>And a 7 on fibroscan is about equal to what in a biopsy?
FS interpretation scales vary a lot in detail. Given that healthy livers come in with FS scores of 4-5
http://www.ncbi.nlm.nih.gov/pubmed/19929903
and at least F2 is likely above 9
http://www.ncbi.nlm.nih.gov/pubmed/19887952
I figured 7 was a good goal.
The actual number is the result of a complex statistical calculation involving the taste of the first sip of beer at the end of a long day, the difference between my life expectancy and current age, and insight into the cosmic game of craps, where 7 is a natural!
HCC (Hepatocellular Carcinoma) scans are routine for anyone who becomes a cirrhotic (stage 4). Even after SVR the risk of HCC does not end for patients with cirrhosis. An ultrasound and sometimes a CT scan with contrast and an AFP blood test are preformed every 6 months to look for indications of HCC.
This is another reason that people with HCV should treat before advancing to stage 4 liver disease.
Cheers!
Hectorsf
This is another reason that people with HCV should treat before advancing to stage 4 liver disease.
Cheers!
Hectorsf
Bree, the risk for developing HCC doesn’t increase until the patient develops cirrhosis.
Most doctors feel it would be irresponsible to order biopsy after SVR; it’s an invasive procedure, and isn’t usually performed unless pathology results somehow alter the course of therapy. It’s not done to satisfy curiosity.
Bill
Most doctors feel it would be irresponsible to order biopsy after SVR; it’s an invasive procedure, and isn’t usually performed unless pathology results somehow alter the course of therapy. It’s not done to satisfy curiosity.
Bill
speaking of hcc scans, should everyone have hcc checks that have/had HCV, should that be a yearly or so check?
how is that checked, through ultrasound?
And a 7 on fibroscan is about equal to what in a biopsy?
Thanks,
Bree
how is that checked, through ultrasound?
And a 7 on fibroscan is about equal to what in a biopsy?
Thanks,
Bree
no idea what the status of FDA approval is - the whole area of fibrosis measurement seems intrinsically murky. There's also cost - though the exam is trivial a European hepa told me the machines are pricey.
I plan to keep checking for two reasons - if I can get under 7 I'll feel OK about having a beer and stopping the hcc scans.
I plan to keep checking for two reasons - if I can get under 7 I'll feel OK about having a beer and stopping the hcc scans.
Fibroscans are not common in Canada as yet at all, it's still biopsy here except for major centres.
"Also known by its brand name, Fibroscan, transient elastography is an advanced form of an ultrasound. It allows a healthcare provider to measure fibrosis in the liver in a non-invasive way. Fibroscan machines are available in some liver centres in Canada but are not widely available. "
http://www.infohepatitec.ca/en/detail/testing/types-tests-monitoring-tests
"Also known by its brand name, Fibroscan, transient elastography is an advanced form of an ultrasound. It allows a healthcare provider to measure fibrosis in the liver in a non-invasive way. Fibroscan machines are available in some liver centres in Canada but are not widely available. "
http://www.infohepatitec.ca/en/detail/testing/types-tests-monitoring-tests
Fibroscan is not FDA approved. There are a few scattered around at medical research locations and privately owned. A few people here (in the US) have had them, some withing the context of clinical trials. May be some will tell you how they managed the feat. Fibroscan is more common in Europe and , I guess, Canada.
does anyone know if insurance covers fibroscan?
if not, how much are they?
and my GP (that's all I have now, no liver doctor) said he would order biopsy if I wanted one.
Is that unusual, most doctors won't?
if not, how much are they?
and my GP (that's all I have now, no liver doctor) said he would order biopsy if I wanted one.
Is that unusual, most doctors won't?
I had a biopsy before first treatment but not after the second. After SVR there's really no medical reason to need a biopsy unless other medical reasons require it. Curiosity about expected liver improvement is not a reason. I'd be surpised if a reputable doctor would suggest it and order it. That's why a fibroscan would be nice, but also not really medically necessary.
guy, since tx, you have not had biopsy to check on the liver? I assume you had an initial biopsy? I thought the associated risk was minimal, how many others do biopsy to check on the liver after they have SVR?
I just would like to know how the liver has healed after a while, just wanted to know if others here have done follow up biopsy or are planning on doing that?
Thanks,
Bree
Having access to fibroscan is a pretty cool concept. Here in the States there are very few of them (about 5 places or so , I think). My wish was to be able to see the progress in the expectation that the 'ol liver is healing itself. The only reliable way to do that would be a biopsy and a bisopsy is not a reasonable alternative due to the assocaited risk. So, biospsy is out of the question - I'm not that curious
As a result, all I have is go by are regular bloods test (like CBC and LFT) and receommended CT's and Ultrasounds to screen for stuff like HCC. I haven't been pursing the imaging, though. The blood stuff is good.
I have some to a conclusion. If the curiosity deals only with improvement of fibrosis (or early cirrhosis) it's truly just a curiosity. Even if there was no improvement in fibrosis, what could you do about it anyway? Basically, watch it not improve or pursue hoped for improvement with bunches of twigs, pebbles and exotic sounding supplements. And, the thing about all the twigs, pebbles and supplements is how do you know that they are doing what's expected unless you have access to biopsy or undergo unecessary biopsies. Even then how can a person quantify the effect of the twigs as compared to the un-HCV's liver without the twigs?
In the meantime, I'll enjoy reading your news beacuse your partner's siutuation and mine were very similar with me being a year or two ahead in timing and he's got access to a fibroscan and a good person to watch out for him.
As a result, all I have is go by are regular bloods test (like CBC and LFT) and receommended CT's and Ultrasounds to screen for stuff like HCC. I haven't been pursing the imaging, though. The blood stuff is good.
I have some to a conclusion. If the curiosity deals only with improvement of fibrosis (or early cirrhosis) it's truly just a curiosity. Even if there was no improvement in fibrosis, what could you do about it anyway? Basically, watch it not improve or pursue hoped for improvement with bunches of twigs, pebbles and exotic sounding supplements. And, the thing about all the twigs, pebbles and supplements is how do you know that they are doing what's expected unless you have access to biopsy or undergo unecessary biopsies. Even then how can a person quantify the effect of the twigs as compared to the un-HCV's liver without the twigs?
In the meantime, I'll enjoy reading your news beacuse your partner's siutuation and mine were very similar with me being a year or two ahead in timing and he's got access to a fibroscan and a good person to watch out for him.
Sorry ..forgot he article
Diagnostic accuracy of FibroScan and comparison to liver fibrosis biomarkers in chronic v
Journal of Hepatology (December 2010)
Francoise Degos1Corresponding Author Informationemail address, Paul Perez2, Bruno Roche3, Amel Mahmoudi4, Julien Asselineau2, Helene Voitot5, Pierre Bedossa6, for the FIBROSTIC study group
Received 15 February 2010; received in revised form 5 May 2010; accepted 22 May 2010. published online 23 August 2010.
"The overall accuracy of FibroScan® was as good as or better than that of other non-invasive methods......The diagnostic accuracy of non-invasive tests was high for cirrhosis, but poor for significant fibrosis. A clinically relevant gain in the likelihood of diagnosis was achieved in a low proportion of patients. Although the diagnosis of cirrhosis may rely on non-invasive tests, liver biopsy is warranted to diagnose intermediate stages of fibrosis.......The overall accuracy of FibroScan® was high (AUROC 0.89 and 0.90, respectively) and significantly higher than that of biomarkers in predicting cirrhosis (AUROC 0.77-0.86). All non-invasive methods had a moderate accuracy in predicting significant fibrosis (AUROC 0.72-0.78).........According to current practice guidelines, significant fibrosis (F2) is a frequent selection criterion for antiviral treatment of HCV and HBV chronic hepatitis, but the use of non-invasive tests to stage liver fibrosis remains highly controversial. In summary, our study has established that non-invasive tests, especially FibroScan®, may be useful in the prediction of cirrhosis. However, it supports guideline conclusions that non-invasive tests should not replace liver biopsy in routine clinical practice for the detection of significant fibrosis that may warrant treatment [2], [3]."
Diagnostic accuracy of FibroScan and comparison to liver fibrosis biomarkers in chronic v
Journal of Hepatology (December 2010)
Francoise Degos1Corresponding Author Informationemail address, Paul Perez2, Bruno Roche3, Amel Mahmoudi4, Julien Asselineau2, Helene Voitot5, Pierre Bedossa6, for the FIBROSTIC study group
Received 15 February 2010; received in revised form 5 May 2010; accepted 22 May 2010. published online 23 August 2010.
"The overall accuracy of FibroScan® was as good as or better than that of other non-invasive methods......The diagnostic accuracy of non-invasive tests was high for cirrhosis, but poor for significant fibrosis. A clinically relevant gain in the likelihood of diagnosis was achieved in a low proportion of patients. Although the diagnosis of cirrhosis may rely on non-invasive tests, liver biopsy is warranted to diagnose intermediate stages of fibrosis.......The overall accuracy of FibroScan® was high (AUROC 0.89 and 0.90, respectively) and significantly higher than that of biomarkers in predicting cirrhosis (AUROC 0.77-0.86). All non-invasive methods had a moderate accuracy in predicting significant fibrosis (AUROC 0.72-0.78).........According to current practice guidelines, significant fibrosis (F2) is a frequent selection criterion for antiviral treatment of HCV and HBV chronic hepatitis, but the use of non-invasive tests to stage liver fibrosis remains highly controversial. In summary, our study has established that non-invasive tests, especially FibroScan®, may be useful in the prediction of cirrhosis. However, it supports guideline conclusions that non-invasive tests should not replace liver biopsy in routine clinical practice for the detection of significant fibrosis that may warrant treatment [2], [3]."
Fibroscan scores are fairly accurate when interpreting cirrhosis .as per the recent article below,20kpa is still considered a reading of stiffness of cirrhosis,however certainly better than the 30 8 months ago.Seeing as he had successful treatment .I would imagine it is not too good to be true to have reduced stiffness reading....great news!.
Btw..my two fibro"s at TW exactly correlated with the 2 biopsys I had..
Good luck to your partner in Aug.
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