Is a biopsy necessary??

Question

Went to my GI Dr today to discuss my test results. Had to redo the genotype test cause the lab messed up...anyways he said my liver ultrasound looked pretty good. A little fatty liver but nothing alarming. Also a slightly enlarged spleen, which he said was fine too. He wants me to start treatment once we know my genotype. I asked if i needed a liver biopsy first and he said no. From reading this forum, it seems almost everyone says to get a liver biopsy before starting treatment. Do you think I should tell my Dr I want a biopsy, or just jump right into treatment? Any thoughts/comments will help, thanks!!

summer7799 · Answer

That makes sense. Guess I need to know my genotype before knowing what step to take next. I honestly would rather treat now and just get it over with!

Willy50 · Answer

"So basically he says just wait for genotype and start treating."
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If you happened to have minimal damage I might consider waiting even longer to treat.  It looks to me like some safer, shorter and easier treatments are coming.

If you happen to be a genotype 3 the new PI's will not be useful to you, if so I would strongly consider waiting.

-W

Willy50 · Answer

I kinda skimmed this, but why not get a simple blood test; a fibrosure?  They are often considered to be in the area of 85% accuracy of a biopsy.  They are quick, relatively accurate, cheap, outpatient and safe.  You'll likely have results within days.  My copay was about 25 dollars when I took one a few years back.  If it turns out that you have minimal damage...... you probably have time.

On the other hand, if you seem to have moderate or significant damage, then yes..... I'd consider a biopsy if you plan on waiting.  I'd decide based on the data I got from the test and consult w/ the doc, or float it out here before searching out a hepatologist.  If you are a stage 1 you have some time to shop......

Willy

summer7799 · Answer

Thanks everyone for your advice. I think I will discuss my concerns for a biopsy with the Dr at the next appt. A friend of mine referred me to this gastroenterologist. He treated my friend last year for hep c, before the new drugs came out. My friend is in his 50's and had geno 1. This Dr sent him for EKG and biopsy before treatment. My friend just went for 6 month post treatment appt and is UND. My friend had overall good experience with this Dr and treatment. So maybe it is my age that the Dr does not see the need for other exams. But I will ask again to ease my mind. Thanks friends!!

frijole · Answer

Summer, I don't think you can take this too seriously .  Do you live in a metroplex?  A hepatologist is a gastrointerologist specializing in the liver and they have much more experience in treating Hep C.  If you can find one, I recommend to treat with him (her).

The term "looks good" doesn't tell you much , does it?  The ultrasound cannot detect the amount of inflammation and fibrosis you might have but a biopsy will.

willbb · Answer

Well..try not to stress...sometimes easier said than done I know  :)

First of all you are only 33 I see from your profile ..so the chances of you having significant liver damage is unlikely,however the reason I feel a biopsy is important is because if say you are stage 0 or even st 1 damage then you may want to delay treatment until even more efficient drugs come along. I am one that believes (and others may disagree) that in time these meds are going to get better and better and it looks like in all likelihood Interferon may very well be out of the mix in the next few years(how long is a question tho..no-one yet knows)

So.. without a biopsy you would not know what to do in this regard.

Having said that if you are intent on treating now(and that is never a bad idea in my opinion with approx 75% success rate now) then I guess your doctor "s opinion on not having a biopsy is valid .

as far as changing doctors that is always a personal desicion...you want one that is experienced (with treating HCV) and that you feel comfortable talking to and feel will be there for you .
The EKG  is usually run on patients that are somewhat older than you ..who may have heart problems ..as the meds can have adverse effects if indeed you have those problems..however because of your age..your doc  does not seem to concerned .

The U/S   can show certain things like enlarged liver  nodular formation size of portal vein (all which can indicate cirrhosis possibly ,however is not a good test for gauging liver fibrosis) ..the biopsy is still the best we have there.

So..Hope I haven"t confused you further. and as far as seeking another opinion from another doc it is a personal choice

Best to you

Will

summer7799 · Answer

Should I try a different doctor? I'm seeing a gastroenterologist now. Is there another Dr that might be better? Or should I just keep my Dr and tell him I want a biopsy? I'm stressing out about this. I'm so uneducated about all of this. Many people talk about getting an EKG before treatment. My Dr said I don't need that either. It just seems like he is taking this lightly. Or maybe I am just taking it too seriously? If my liver ultrasound looks "good", is it stil possible to have liver damage that only a biopsy can detect? I don't want to feel like I have to be on top of my Dr, I want my Dr to take care of me! Please give your advice, thanks :)

willbb · Answer

Knowing your Geno type is paramount to diagnosis ..especially as it pertains to treatment regime..also personally I agree with the others. that a biopsy(or at the very least a fibroscan and /or a fibrosure test) is needed info. to  know exactly how to move forward.

Having st 0 liver damage is completely different than having stage 4 cirrhosis ..when it comes to making decisions regarding treatment.

It would not be acceptable to me personally if my  doctor said " your liver is fine  and   we will just start treament without having all the info possible

Good luck
Will

summer7799 · Answer

My report said a normal sized spleen is 12 and mine is 12.3 (just slightly enlarged) Also my Dr said I have small amount of fatty liver. I dont have a copy of the results. So I have no idea waht small amount means. Is any amount of fatty liver bad? Regarding the platelets and other blood results, he said everything is in normal range. He seemed like I was fine and not concerned at all. This is why he feels I dont need a biopsy. I asked about an EKG before treatment and he said those tests are for people who have had previous conditions. So basically he says just wait for genotype and start treating. Do you think I should just start or get a second opinion? What kind of dr should I see? My primary told me to go to a gastro....what else is there??

summer7799 · Answer

My dr said he wants me to start the new drugs also. Once we get my genotype he will start. So you did not get a biopsy before starting? What kind of specialist are you seeing? I just feel like I have so many questions and my dr seems like its no big deal. I guess he thinks my liver and everything else is fine. Im just a little concerned that he doesnt think I need to do anything before treatment.

frijole · Answer

I agree with what most people have said here.  Get a biopsy.  A slightly enlarged spleen and a fatty liver should raise an alarm.  If I were you I would want to know exactly what lies ahead.  Besides, the treatment protocol is different for patients with advanced fibrosis.
frijole

HectorSF · Answer

Just a note...
"a slightly enlarged spleen" I am not sure what "slightly means". On ultrasound reports it should say the size in inches.
An enlarged spleen can be caused by many illnesses, one being advanced liver disease.
What is your platelet count? Under 100,000?
Are all your labs values within norms?
Get a copy and post here and bring all lab reports to second opinion doc.

Enlarged spleen and low platelet count, could be, an indication of advanced liver disease. You are young so normally the disease shouldn't have progressed to that point yet but it is possible. Patients can take from 20-30 years to develop advanced liver disease.

I would get a second opinion from a hepatologist if i were you. Gastro are not experts on the liver.

Good luck.
Hector

beeblessed · Answer

Hi Summer.  It's important to know your genotype so you will receive appropriate treatment.  I would ask why he doesn't feel you should have the liver biopsy.  That said, I finally decided to go through with it, then my doc told me I didn't need one after all, as I would be treated with the new drugs (that FDA approved in May).  When I asked her if she felt that way just about me or patients across the board -- she said across the board.  Every body's body and circumstances are different.  If you are not sure about your doc's opinion, it's a good idea to get a second opinion, preferably from a Hepatologist or a Gastro doc who is used to treating Hepatitis patients.  Best to you.

grizwald · Answer

Sorry to alarm you.  What I said was "LIKE for new treatments coming out soon".  The word like in this sentence was intended to let the reader know this was only an example of the diffrent ways the biopsy could be used. i.e.  A Yr. ago we knew new meds were coming out soon, so the question was, treat right then, because your liver couldn't wait any longer  or not treat untill the new meds were available.  This was not a statement about new meds. coming out soon.

Griz

Aaron57 · Answer

Can you give some data or links to what you suggest are "new meds coming out soon" ?

Clinical trials take many years, sometimes up to 10 years .. and even if "fast tracked" the process takes time . Many folks have been waiting many years for the 2 PI's that were approved in April this year by the FDA ... 

It seems unlikely that the next generation of HCV Tx drugs will be "coming out soon" . 
Only 2 drugs are in CT phase 3 at this time .. and no guarantee they will be approved .. though they both do have good results so far .. 

http://www.hcvdrugs.com/

grizwald · Answer

I think a biopsy is used to determine the current amount of damage to the liver, to help decide whether to treat or maybe wait, (like for new treatments coming out soon).  It sounds like that decission has been maid so your Dr. may not call for a biopsy.  Ask him.

Good luck,

Griz

lal959mik · Answer

GI doctors don't specialize in the liver.  I had one told me the same thing he didn't tell me that I had a enlarged spleen.  So I went to a Hematologist and will be starting treatment soon.