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Post Info TOPIC: Is biopsy necessary for all HEP C patients?


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RE: Is biopsy necessary for all HEP C patients?
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my dr is at mt sinai and i told her i was very afraid of the biopsy (though would do it if she told me i needed to) and she said they can do it another way that sounds scary but is less painful. (transjugular- they sedate and go in through the jugular). i'm going to start treatment so she said she didn't think it was necessary to do it. i've had a normal one before and it's not fun but the discomfort doesn't last. i just wished someone had warned me. 



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Thanks in advance,

Chris aka 'Bird in Hand'

<<Gen 1b, VL 5mill, contracted from blood tranfusion in 1985 at age 13, now 40; starting triple therapy early next year.>>



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Thanks Malcolm, you are a great help. I hope you are feeling better these days.



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Geno type 1b, F1 vl 640,000 enrolled in Gilead's sofosbuvir/ledipasvir -week 1 66, week 2 <25



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Re-reading my post, my comments about liver biopsy seem a bit flippant. Serious complications are rare but possible. I did get some R shoulder-tip pain after one biopsy, but that rapidly settled with a panadeine. Doing a core biopsy using a 16 gauge needle causes liver bleeding. When blood tracks below the liver capsule, this will cause pain. A lot depends on the skill of the person doing the biopsy. In Teaching Hospitals, training Residents or Registrars are rotated through the liver biopsy sessions. I would want to know who was doing the biopsy, and be prepared to pay for an experienced Radiologist or Hepatologist. Adequate local anaesthesia to the liver capsule is required, with mild sedation of anxious patients , and imaging (by ultrasound or CT) is necessary so a good core can be obtained safely with just 1 or 2 passes , avoiding major blood vessels, bowel or gallbladder.



-- Edited by mallani on Monday 23rd of July 2012 08:19:22 AM

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Geno 1b, IL28B CT,  x3 prior relapser,  ex-cirrhotic, 75 yo, did 48 weeks with Victrelis/Peg./Riba.  VL 1.28m at start, UNDET. at 8 ,12 ,16 ,24 ,30  and 48 weeks.  EOT 15 Feb 2013 , UNDET. at EOT + 28 weeks. SVR!  Still Undet. at EOT +5 years

Malcolm



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U/S is Ultrasound. Yes, you can have normal liver function tests, including bilirubin, albumin and prothrombin time, and still have cirrhosis. Also, your viral load does not relate to liver damage or fibrosis.



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Geno 1b, IL28B CT,  x3 prior relapser,  ex-cirrhotic, 75 yo, did 48 weeks with Victrelis/Peg./Riba.  VL 1.28m at start, UNDET. at 8 ,12 ,16 ,24 ,30  and 48 weeks.  EOT 15 Feb 2013 , UNDET. at EOT + 28 weeks. SVR!  Still Undet. at EOT +5 years

Malcolm



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Malcom: What does U/S changes mean? I am not familiar with this abreviation. Can you have normal bilirium,ast,alt,liver function and still have cirrohsis?? I am confused.

 

 



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Geno type 1b, F1 vl 640,000 enrolled in Gilead's sofosbuvir/ledipasvir -week 1 66, week 2 <25



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They have fibroscan at MT sinai in NYC because it's a school so that's where I went for mine... It was awesome/non invasive... and it was completely accurate... wish they started doing that in US instead of biopsy... had a biopsy after to check the accuracy and it was right - stage 2 fibrosis



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Allison, Genotype 1b. Started triple Tx (Victrelis) - 2.27.12 Viral Load started at 6.5 Million. Liver Biopsy- early stage 2 fibrosis. Und Wks 4-16. End Of Tx will be 9.9.2012 :)



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I'm with Mallani. I've had 2 and never had any ill effects. I'd rather know how fibrous my liver is or isn't than not know.



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Geno 1a, Viral load at 2 4, 8, 12 and 16  weeks, UND, Triple therapy Incevek done,   Peg & Riba Done, UND and making plans for the future!!



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Thank you for all your responds regarding biopsy. I guess it is just a sure way of knowing how your liver is doing. We don't have fibroscan in the US.



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Geno type 1b, F1 vl 640,000 enrolled in Gilead's sofosbuvir/ledipasvir -week 1 66, week 2 <25



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Alan is correct. The 6 monthly ultrasound is only to check for HCC. Liver ultrasound is not a good test for cirrhosis. I am cirrhotic, by biopsy and fibroscan, but my liver U/S is completely normal. Papers have been written about using U/S to measure degree of cirrhosis using sharpness of liver edge, liver echotexture and smoothness of liver surface. When cirrhotics start to decompensate, then you may see definite U/S changes.

Unfortunately, liver function tests give no idea of liver fibrosis. Cirrhotics may have normal LFT's. The other blood tests for bilirubin, albumin, prothrombin time etc. will only become abnormal when a cirrhotic liver starts to decompensate.

I have had 3 biopsies. They are a piece of cake. Fibroscan is the only other reliable way to assess liver fibrosis.

I agree that for most people, liver biopsy is not required, but for treatment protocols, you should know whether you have cirrhosis. Symptoms and blood tests will not tell you this.



-- Edited by mallani on Sunday 22nd of July 2012 02:53:51 PM

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Geno 1b, IL28B CT,  x3 prior relapser,  ex-cirrhotic, 75 yo, did 48 weeks with Victrelis/Peg./Riba.  VL 1.28m at start, UNDET. at 8 ,12 ,16 ,24 ,30  and 48 weeks.  EOT 15 Feb 2013 , UNDET. at EOT + 28 weeks. SVR!  Still Undet. at EOT +5 years

Malcolm



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My doctor also referred to biopsies as out dated and no longer recommended as routine practice, which I was happy to hear. But I suspect if the blood work, upper GI, or ultrasound indicated otherwise, he would have required one, and I would have complied. It was never an issue with insurance.



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Geno 1A, VL 1.9 mm, SOT 12/2/11 - Pegintron/Ribavirin/Victrelis, UND since wk 8, EOT 6/15/12 (28 wks), SVR 11/30/12



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im in week 37 of treatment and have never heard the biopsy in regard to my treatment. i do know someone who did, but she had a bad liver.



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kiwi. genotype 1. started pegasus and riba on 10 nov. VL 17.6 million. (4 weeks VL 1368)  week 15 UNDETECTED... :)



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My doctor referred to a liver biopsy as the "tarnished" gold standard.  He did not recommend me having one, unless....it would help sway my decision to have treatment or not.



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Geno Type A1- VL 16.2m - F1-F2 Moderate Fibrosis - Started treatment 4/16/13 Sofosbuvir/Ledipasvir 6 months -  UND week 4 (5/14/13) - EOT 10/1/13 - 12wk blood draw 12/20/13 UND - 24wk/final blood draw March 2014



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I had to get one prior to beginning treatment, but there has been no talk of a repeat.... Ever. They do say I'll need a ultrasound every six months forever. But that's for cancer, not for hepatitis. I guess I can live with that. Aside from the risks involved in stabbing a long, large needle between two ribs into one of the most important organs in the body, what's so bad about a biopsy (just kidding, of course) ? It scared me silly. But the doctor claims he got good data on the condition of my liver. I had to go with it. Alan

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Geno 1A  Started Pegasys/Ribavirin/Incivek Nov. 20, 2011 .  Completed July 28, 2012 (36 weeks). For a treatment history, see:  https://jshare.johnshopkins.edu/xythoswfs/webview/_xy-9921874_1

SVR on January 14, 2013!!



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I was always pressured to dO a biopsy but never actually did it. Ultrasound showed minor scaring and liver enzymes were always in the norm, meaning no inflammation.

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Geno 1b, relapsed in 2009 a week before my treatment was to be over. Started triple therapy on April 28th, 2012. UND at week 4,8,12,24,3 months post tx.



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Hi Nancy,

From what I've heard- the risk of infection(or complications) from doing a biopsy usually outweighs the value of any useful information gathered.    My doctor relies upon the labs and a periodic ultrasound for collecting information on the status of the liver; not getting a biopsy is definately not breaking my heart any.



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"hrsetrdr"=Tim

Treatment halted on Aug.8,2012 due to vision problem.  6 month post tx labs

Aug.2013 SVR

Be strong when you are weak, brave when you are scared, and humble when you are victorious.
- Unknown

 

 



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My doctor wants to do a biopsy, and I am not sure why all doctors want to do biopsy. Is it going to hurt my liver? I have been putting it off for a while, please advise. My liver enzyme are back to normal and my viral load have gone down alot.

Thanks.

Nancy



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Geno type 1b, F1 vl 640,000 enrolled in Gilead's sofosbuvir/ledipasvir -week 1 66, week 2 <25

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