Thanks, Malcolm. No, no, not confusing at all. Find it very clear and educative. As all the stuff, that you post Keep well!
mallani said
Nov 8, 2012
Hi Bouba, we are getting away from Steff's post. The problem with liver biopsy has always been the dependence on the skill of the Biopsier and the Pathologist. Added to that is the fact that only 1 or 2 segments of the R liver lobe are sampled. Cirrhosis may not be uniformly spread though the liver, so there is always the risk of over-reading or under-reading the Fibrosis Stage by + or - 1. You are correct in that Fibroscan is very accurate for F0-1, and for F4 ( ~95%) . Calibration seems to vary but 0-6 kPa is F0-1, and >19 kPa is F4. F3 seems to start at ~10 kPa. So anything from 6-10 is F1 or F2. Bit confusing, but better than the other non-invasive formulae. Cheers.
Bouba said
Nov 7, 2012
Thanks, Malcolm, for your prompt reply. Noteworthy, and I am talking of my own experience, that it is uneasy to establish a good correlation between biopsy and fibroscan results. Unless you do both simultaneously and perhaps several times. Which, as you said, no one would line up for. I had a minor and mild inflammation on 2 biopsies done in 2000 and 2004. And already F3 fibrosis on the last one 2 months ago. While in between, 2007 and 2009 fibroscans showed 4.5-4.7 kPa, with fibrosis starting benchmark anywhere between 8 and 12. I was surfing on the web trying to find an answer but it seems there is no consensus on this matter. The bottomline of what I have found was
qte FibroScan have excellent utility for the identification of HCV-related cirrhosis, but lesser accuracy for earlier stages. Refinements are necessary before these tests can replace liver biopsy.unq
In simple words this would mean that fibroscan works in case of a very mild (good elacticity) inflammation or a cirrhotic liver but could have quite an overlap in readings between a moderate and stage 3 phase?
While biopsy tissue is very segmental as well and may not represent the processes in the entire organ, though giving a good indication of what is going on.
Do I read it correctly? Is there a solution to a more accurate findings?
Cheers!
mallani said
Nov 7, 2012
Hi Bouba, no antifibrotic drugs have been approved. Many are being studied, mostly collagenases that can resorb fibrosis. Most researchers now seem to agree that liver fibrosis can be reversed, particularly if SVR is attained. Even a course of failed Rx seems beneficial in many cases. One of the main problems is getting repeated, accurate histological diagnosis. Nobody is going to line up for repeated liver biopsies, so there is a lot of guesswork. Biopsies can give false results (+ or - two grades). It's a very complex issue but it gives me some joy. Cheers.
Bouba said
Nov 7, 2012
Malcolm et all,
Has anyone heard of antifibrotic meds coming into the market? I recall I read something about it but could not trace it back. My doc told me that eradication of the virus will reverse the fibrosis, but yet I wonder if there is a supplementary treatment available. Assuming the virus is UND, how long can it take from that point to have the fibrotic tissue fully regenerated from F3? Thanks in advance for an insight. Cheers!
mallani said
Nov 7, 2012
The Abbott results are very impressive. The quadruple Rx should really take care of mutations. For the next trials, I hope they do a breakdown into liver fibrosis subgroups. We are seeing some improved figures for Geno 1b compared with 1a- this is not surprising considering the 1b structure is more stable.
Interesting link
http://www.hepatitisaustralia.com/__data/assets/pdf_file/0013/1534/Fibroscan_Transient_Elastography.pdf
Thanks, Malcolm. No, no, not confusing at all. Find it very clear and educative. As all the stuff, that you post
Keep well!
Hi Bouba, we are getting away from Steff's post. The problem with liver biopsy has always been the dependence on the skill of the Biopsier and the Pathologist. Added to that is the fact that only 1 or 2 segments of the R liver lobe are sampled. Cirrhosis may not be uniformly spread though the liver, so there is always the risk of over-reading or under-reading the Fibrosis Stage by + or - 1. You are correct in that Fibroscan is very accurate for F0-1, and for F4 ( ~95%) . Calibration seems to vary but 0-6 kPa is F0-1, and >19 kPa is F4. F3 seems to start at ~10 kPa. So anything from 6-10 is F1 or F2. Bit confusing, but better than the other non-invasive formulae. Cheers.
Thanks, Malcolm, for your prompt reply. Noteworthy, and I am talking of my own experience, that it is uneasy to establish a good correlation between biopsy and fibroscan results. Unless you do both simultaneously and perhaps several times. Which, as you said, no one would line up for. I had a minor and mild inflammation on 2 biopsies done in 2000 and 2004. And already F3 fibrosis on the last one 2 months ago. While in between, 2007 and 2009 fibroscans showed 4.5-4.7 kPa, with fibrosis starting benchmark anywhere between 8 and 12. I was surfing on the web trying to find an answer but it seems there is no consensus on this matter. The bottomline of what I have found was
qte FibroScan have excellent utility for the identification of HCV-related cirrhosis, but lesser accuracy for earlier stages. Refinements are necessary before these tests can replace liver biopsy.unq
In simple words this would mean that fibroscan works in case of a very mild (good elacticity) inflammation or a cirrhotic liver but could have quite an overlap in readings between a moderate and stage 3 phase?
While biopsy tissue is very segmental as well and may not represent the processes in the entire organ, though giving a good indication of what is going on.
Do I read it correctly? Is there a solution to a more accurate findings?
Cheers!
Hi Bouba, no antifibrotic drugs have been approved. Many are being studied, mostly collagenases that can resorb fibrosis. Most researchers now seem to agree that liver fibrosis can be reversed, particularly if SVR is attained. Even a course of failed Rx seems beneficial in many cases. One of the main problems is getting repeated, accurate histological diagnosis. Nobody is going to line up for repeated liver biopsies, so there is a lot of guesswork. Biopsies can give false results (+ or - two grades). It's a very complex issue but it gives me some joy. Cheers.
Malcolm et all,
Has anyone heard of antifibrotic meds coming into the market? I recall I read something about it but could not trace it back. My doc told me that eradication of the virus will reverse the fibrosis, but yet I wonder if there is a supplementary treatment available. Assuming the virus is UND, how long can it take from that point to have the fibrotic tissue fully regenerated from F3? Thanks in advance for an insight. Cheers!
The Abbott results are very impressive. The quadruple Rx should really take care of mutations. For the next trials, I hope they do a breakdown into liver fibrosis subgroups. We are seeing some improved figures for Geno 1b compared with 1a- this is not surprising considering the 1b structure is more stable.
http://www.hcvadvocate.org/news/newsLetter/2012/advocate1112.html