fibrosure

[jennylynne102]

how accurate is a fibrosure test? Has anyone had one? Should I get a biopsy?

[JennyPenny]

Biopsy is considered the gold standard. Whether you should get one or not is a matter of opinion and you know what they say about opinions. I can only tell you that personally I went with a biopsy. Some people are afraid enough of the biopsy to do the other less invasive tests and I guess they are better than nothing. I've heard that they are good for people with very little damage, or lots of damage to the liver. Those who fall in between don't get such good results. At the same time biopsy has a 30% sampling error.

I know this didn't answer your question very well. I'm sorry about that. I wish we had better answers.

[copyman]

the FibroSURE would be a good starting point considering it is non-invasive and costs way less then "gold standard" biopsy. It is very reliable to rule out cirrhosis. Also you could get a FibroSCAN if you happen to live in an area where they are located. The SCAN machines are only in a few places in the USA and have yet to be approved by the FDA. They are readily available in other countries. Once again these are similar to the FibroSURE and only accurate on the low & high ends, not that accurate for middle stages. getting a biopsy is not always necessary depending on your genotype and treatment plans.

[Bill1954]

I personally have very mixed feelings about the Fibrosure. If you are currently on treatment, don’t *even* consider it; I took one on treatment, and scored F .92; pretty scary—

Bill

[Bill1954]

Oh, and even if the test was taken under good conditions, neither of my liver docs would apply any diagnostic weight to it. Their NP ordered it… against my objections. It *might* provide some use, if used in conjunction with all the other diagnostic tools--

Bill

[JennyPenny]

I totally agree with Bill and so does my doctor.

[copyman]

My docotr uses the fibrosure along with other markers to assess liver damage if the patient doesn't want a liver biopsy. The truth is any good Hepatologist can get an idea of liver damage just from blood work & physical exam.  

The biopsy is not without fault and not that much better then other tests. Unless of course good size non-fragmented samples are taken from 3 different parts of the liver. Or go all out and get a laparoscopic wedge core biopsy. And lets not forget it all comes down to the pathologist preparing the report. If you let three different pathologist read the slides you most likely will get three different results.

My own personal experience showed the FibroSURE, FibroSCAN & Biopsy to be close in result. Even when I consulted with Dr Afdhal in Boston he said the FibroSURE had some creditibility.

Like I said in my previous post the Fibrosure is "a good starting point". It is better then nothing.

[Willy50]

http://www.clpmag.com/issues/articles/2007-04_06.asp
“The correlations between a test like FibroSure and biopsy are somewhere between 70% and 80%. But studies have shown that the correlation between two biopsies on the same patient is also between 70% and 80%,” Faruki says."

http://pt.wkhealth.com/pt/re/jgah/abstract.00001753-200905000-00016.htm;jsessionid=KvBT1R63L6FFgPM4BMBxQx1zMF5S6zQnmJm14mjc1h4ztL0HJFLN!-1301
"Results: The testing algorithm using Fibrosure was the most accurate non-invasive strategy with a sensitivity, specificity, and overall accuracy of 84%, 87%, and 86%, respectively. In comparison with liver biopsy alone, there was a cost savings of approximately $770/person with the Fibrosure testing algorithm, but a net decrease in accuracy of 14%. Fibrospect II and Fibroscan had poorer accuracy (decreases of 12% and 4%, respectively) and lower costs (-$138 and -$357, respectively) compared with the Fibrosure algorithm. In uncertainty analyses in which biopsy sampling error was considered, the Fibrosure algorithm remained consistently less accurate (5-14% decrease)."
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I had a fibrosure in 2005 which showed stage 1.  I had a biospy in 2008 which showed 1/6 ishak.   Fairly close.  My out of pocket after the fibrosure was about 25 bucks.  

I guess that I wonder if there was some correlation it might allow people to keep a closer track as they near and enter cirrhosis.  Maybe a biopsy is more accurate, but are you going to get one per year?  Many folks with Meld scores are steered away from biopsies since they can be more risky for cirrhotics.  

I guess I wonder if having a fibrosure would be a good idea to create a baseline.  One could do another each year.  One normally gets many of the same labs anyway in liver panels.

Finally, to some extent, the more tests the better the overall picture.  
Not all patients have world class hepatologists, even if they did....would they all agree?

best,
Willy

[copyman]

great post Willy

[pjhep80]

i've had both, biopsy about 5 years ago and fibrosure blood test about a year ago, they both said the same thing, stage 2 grade 2

[snadge]

theres a lot of debate about the accuracy of the FIBROSCAN test
i Had a Biopsy in 2006 that came back as Fibrosis 2 / Inflammaton 7 and 2 years later my Fibroscan said 3.3 which is excellent - so work that one out?

my nurse says that they NEVER use fibroscan results only but all three (Fibroscan , Ultrasound, Biopsy) to paint an overall picture of ones liver state

so YES you should have a fibroscan , biopsy and ultrasound

[Willy50]

By the way, welcome to MH.

A fibroSCAN (which uses sound waves that bounce off a liver) is a different test than a fibroSURE which is a blood test which uses a variety of blood labs to approximate a liver staging score.  I think that each type of test has it's strengths and weaknesses.  Together may may help comprise a very good view of a patients staging.

Some of the function of these tests is to standardize results and may in part remove the need of some of the art, experience and expertise of the doctor.  The goal might be that a so-so doctor and end up achieving the same assessment as a world stage hepatologist.

Willy

[Bill1954]

I personally feel that the Fibrosure/Fibrospect tests yields inferior results when compared to needle biopsy. It can’t provide any information on inflammation, and its clinical utility in determining fibrosis is questionable. One of my doctors told me that although the ‘numbers’ are there to support it’s approval by the U.S. FDA, in the real world, it really isn’t worth much.

This makes me wonder about its use in any scenario; what is the benefit in utilizing an inferior test? If it’s included as a third partner with biopsy and perhaps Fibroscan, doesn’t this simply sully the other results?

And yes, I realize there’s a lot of discussion about the inaccuracy of needle biopsy in here; but I wonder how much of this is attributable to internet rumor. Outside of lay discussion, there isn’t much challenge to it, is there? My doctors still swear by it, and continue to embrace the results. I think the liver might be more homogenous in nature than a reader in here is led to believe.

I wish there was a pathologist in here that could lend authority to talks like this--

Bill

[copyman]

sorry the fibroSURE didn't work for you. it clearly states not to have it done while on TX.  Have you ever had one while NOT on TX? Just curious how it would correlate to your BX now.  I will take what a doctor like Dr Afdhal thinks when he says the fibrosure does have creditibility. like i said in my first post it is a great starting point and better then nothing. And it is definately a good test to rule out cirrhosis.

[mhudnall]

Does anyone know where ot get a Fibrosure, Fibrospect Fibrotest, or other non-invasive fbrosis staging test in AZ, CA or the surrounding area?

My doctor will order one, but he's in Washington state and I need to find one closer to home.

Thanks in advance,

Mike H

[copyman]

the fibroSURE is a bloodtest from Labcorp. They have draw sites all over the USA. Go to their website and you will find many locations in every state.

[Bill1954]

Hi Mike,

Any commercial lab should be able to access either the Fibrosure/Fibrospect; Fibrosure is performed by LabCorp. The test results I have list a contact number: [phone]; however, I think all you need is a lab slip from your doc, and a commercial lab.

To my knowledge, there is only one Fibroscan machine out west here, and it is not commercially available. Hepatitis Researcher has access to one in Los
Angeles, but until approval, he can’t take commercial traffic.

Copyman,

I think you might be missing my point. I am SVR, and have no interest for personal testing. My point is that if the Fibrosure results are indeed questionable, why consider the results when we’re trying to find consensus. To exaggerate my thoughts, why not throw a Ouija board into the mix? It’s not very accurate either, so what does that do in terms of consensus? Does that increase your decision power? It *detracts* from decision power, in my opinion--

Bill                

[mhudnall]

Thanks for the contact info. I'll give them a call. Is the Fibrosure an imaging process that goes along with the Fibrospect blood test?

Thanks,

Mike H

[Bill1954]

I believe Fibrosure and Fibrospect are competing, patented computer algorithms; neither are imaging, but attempt to provide fibrosis interpretation using blood markers.

The six values used by Fibrosure are:

Alpha 2-macroglobulins
Haptoglobin
Apolipoprotien A-1
Bilirubin, Total
GGT
ALT (SGPT)

Interpretations:

“Quantitative results of 6 biochemical tests are using a computational algorithm to provide a quantitative surrogate marker  (0.0 – 1.0) for liver fibrosis (Metavir F0 – F4) and for necroinflammatory activity Metavir (A0 – A3).”

Bill

[mhudnall]

I see what you mean about accuracy. I think I would rather couple the blood markers with an imaging test. I was under the impression that there is a commonly used imaging test that work in conjunction with the blood tests. Is that the FibroScan? Does LabCorp do that as well?

From what I've read you have to go to Europe to get a FibroSure, but the FibroScan is available in the US. Maybe LabCorp can tell me, but maybe someone here knows the answer.

Thanks,

Mike H

[mhudnall]

Sorry, I meant to say FibroScan when talking about an available scan in the US in the last post.

MH

[Marcia2202]

The fibrosure and fibrospect are blood tests.

The FibroScan is a scanning machine. They put gel on the area and scan the liver kind of like one does with an ultrasound machine. Except they stay on one place for a long time.

[Bill1954]

No, FibroSCAN is provided by a French company; the name escapes me at the time. I would love to see FibroSCAN here in the U.S.; I think the E.U. adopted it several years ago, and the results appear to be consistently concordant with needle biopsy.  LOL, the names of these tests are so similar, I get them confused in my writing as well :o). Marcia has it spelled out correctly above,


Bill

[Rockerforlife]

The FibroScan will become the standard in the future just the new PI drugs will



http://www.cadth.ca/media/pdf/442_fibroscan_cetap_e.pdf

[copyman]

Bill,
I did not miss your point. I think you missed my point, You said you had the FibroSURE test while on TX which gave you a false reading. Labcorp clearing states NOT to do this test while on TX. My point was asking if you ever had the test done any other time even if you have completed tx and are SVR. Why bash a test if you never did the test the proper way?

Great idea about the Ouija board. I actually put as much merit in that as I would some of the tests out there :-)

the FibroScan machine is from a french company called Ehcosens. I don't think they will ever get FDA approval. After my conversation with one of their representives back in 2007 they said if they didn't have FDA by end of the year they would stop pursuing the USA market.