I am a big fan of Fibroscan. However, it has limitations. These machines are fairly cheap, and operators should be fully trained and be able to produce replicable measurements. Many XRay practices here now have Fibroscan added on as an App. to the regular machines. I know some Sonographers have trouble obtaining the 10+ valid measurements required.
The Fibroscan reading may be high in fatty liver , obese patients and patients who have not fasted for 2-4 hours. Although the newer XL probes are claimed to be more accurate in obese patients ( BMI >30), this is uncertain. The reading is raised in inflammation, particularly during an acute flare.
The mid-range readings ( between 7 and 12 kPa) are unreliable, and Fibrosis stages may vary by one or two stages.
Liver biopsy remains the Gold Standard, although many say 'Imperfect G.S.' Some patients have bad experiences, and many don't like the idea of having a needle stuck into the liver.
When biopsies are done in a large hospital, they are usually done by a junior doctor. Doing a long list of biopsies is bloody boring! The patient doesn't get a thorough explanation, the anaesthesia is not adequate, and sometimes the biopsy samples are difficult to interpret by the Pathologist. A good sample should be at least 3 cms. long, and contain at least 10 portal tracts. Two, ideally 3 samples should be obtained from the R liver lobe.
The advantage of a biopsy is that additional diseases ( like haemochromatosis) will be identified. The amount of fatty infiltration is obvious, not guessed at. The amount of portal tract and centri-lobular inflammation is easy to see. The degree of fibrosis is obvious, and septae or fibrous bands can be counted and measured for thickness. Regenerating nodules are also easy to see.
It is correct that biopsy only samples a small area of liver. Usually, HepC changes are diffuse so this doesn't matter. However it is possible that the area sampled may have more severe or less severe changes. This is why a +/- one stage is considered, unless the patient is cirrhotic.
I think a biopsy should be done initially, then the results monitored by Fibroscan. Just my thoughts. Cheers.
I am getting a biopsy the 28th, also my gallbladder taken out. My Doc is going to use a DaVinci Robot to remove the bladder and take the biopsy, The thing is they also have a cam looking inside you and the Doc can actually see the placement of the biopsy needle and can Cherry Pick the Fibrosis latin areas www.youtube.com/watch?v=qbqpgPDjCM4
Isiscat2011 said
Jul 17, 2014
Hi Malcolm:
In the US biopsies are often performed by physician assistants. I was shocked when I arrived at the hospital for my biopsy and learned, as I was lying on the gurney ready to be wheeled in, that the guy performing the biopsy had never spent a day in medical school. I doubt if many patients would have noticed or questioned this; they simply would not have known.
When I expressed my concerns the PA offered to have a physician perform the procedure. He found a licensed doctor. Long story short it wasn't a pleasant experience nor was it an accurate sampling/reading of my fibrosis. I later wished I would have let the P.A. do it. :)
Hard to view biopsies as a gold standard here in the US when they are often not even performed by well trained physicians.
By contrast, fibroscans (at least for now) are generally being done by Hepatologists or GIs with hepatology training and experience, who work in GI/Hepatology Centers.
Luckydog1953 said
Jul 16, 2014
Well, the FDA and their clinical trials and the AASLD liver experts all say it has 95% reproducibility and they recommend it over biopsies. Also, it is known that fibrosis is generated in areas of inflammatory infiltrate, and that does not occur homogeneously throughout the tissues.
I may be biased but I only had one biopsy and I bled out. Three units of blood later and I bled those out. Then two units of blood later they told me that if they didn't hold they were going in with the rib stretchers. I said, "If these don't hold I'm going out the fire escape!"
Luckily they did hold that time, but I think it is just a little hazardous to give biopsies to people who have clotting problems due to chronic liver disease.
Mike
mallani said
Jul 16, 2014
I am a big fan of Fibroscan. However, it has limitations. These machines are fairly cheap, and operators should be fully trained and be able to produce replicable measurements. Many XRay practices here now have Fibroscan added on as an App. to the regular machines. I know some Sonographers have trouble obtaining the 10+ valid measurements required.
The Fibroscan reading may be high in fatty liver , obese patients and patients who have not fasted for 2-4 hours. Although the newer XL probes are claimed to be more accurate in obese patients ( BMI >30), this is uncertain. The reading is raised in inflammation, particularly during an acute flare.
The mid-range readings ( between 7 and 12 kPa) are unreliable, and Fibrosis stages may vary by one or two stages.
Liver biopsy remains the Gold Standard, although many say 'Imperfect G.S.' Some patients have bad experiences, and many don't like the idea of having a needle stuck into the liver.
When biopsies are done in a large hospital, they are usually done by a junior doctor. Doing a long list of biopsies is bloody boring! The patient doesn't get a thorough explanation, the anaesthesia is not adequate, and sometimes the biopsy samples are difficult to interpret by the Pathologist. A good sample should be at least 3 cms. long, and contain at least 10 portal tracts. Two, ideally 3 samples should be obtained from the R liver lobe.
The advantage of a biopsy is that additional diseases ( like haemochromatosis) will be identified. The amount of fatty infiltration is obvious, not guessed at. The amount of portal tract and centri-lobular inflammation is easy to see. The degree of fibrosis is obvious, and septae or fibrous bands can be counted and measured for thickness. Regenerating nodules are also easy to see.
It is correct that biopsy only samples a small area of liver. Usually, HepC changes are diffuse so this doesn't matter. However it is possible that the area sampled may have more severe or less severe changes. This is why a +/- one stage is considered, unless the patient is cirrhotic.
I think a biopsy should be done initially, then the results monitored by Fibroscan. Just my thoughts. Cheers.
Luckydog1953 said
Jul 16, 2014
I like the fact that the area that the FibroScan tests is 100 times bigger than the area that the biopsy tests. Also, the fact that ten FibroScan shots are averaged; it is clear that any variation in correlation is on the biopsy side, not the FibroScan's. Monitoring twice a year will be great as well instead of waiting every 3-5 years for a biopsy.
The one thing that many of us HCV patients desperately want to know is what is my fibrosis stage? Liver enzyme blood tests are not relevant to fibrosis staging; neither are Viral Load tests. The only thing that really matters is fibrosis staging, and now we can do it safely and frequently, without fear of bleeding out (that's what happened to me in my one and only biopsy).
I am stoked with the news, and I have already had my FibroScan last week in Scottsdale!
Mike
suziq said
Jul 16, 2014
Hi All,
Found a link for finding where the FibroScan machines are in the U.S.
Go to the Find a facility on the right of the page and click
Then click on your state to find if there is one near you. Note: When I saw the blank map, I thought there weren't any until I clinked on my state. I am not the brighteset star in the heavens.
SuziQ
Isiscat2011 said
Jul 16, 2014
Good to know that insurance plans will soon be covering fibroscans. Just wanted to add that, in the meantime, if you are able to pay out-of-pocket some medical providers will give you a cash discount that usually ranges from 10-25% off.
My last fibroscan, which was in the US, cost $300 cash. I'm not sure if that included a cash discount or not. In Canada my fibroscan cost about $450 USD (for a US citizen).
Thanks, Mike.
Luckydog1953 said
Jul 16, 2014
Not a question, but just an update on the FibroScan technology in the US which is a non-invasive method to measure fibrosis staging (replacing the needle biopsy). In 2013 the FDA approved the FibroScan technology and in 2014 the AASLD endorsed the FibroScan technology. The FibroScan is technically called Vibration Controlled Transient Elastography (VCTE) and it measures liver stiffness that correlates with liver fibrosis staging. This new technology is replacing the needle biopsy and the advantages are that the procedure in non-invasive, painless, requires no hospitalization and all major insurance plans will soon cover two FibroScans per year. The scans are relatively inexpensive for those who are not covered - about $350 is the going rate. Private medical institutions have bought most of the machines but a couple independent private clinics have opened up in Phoenix and Los Angeles.
Regular live monitoring is very important for liver disease patients and the FibroScan technology will also save the health care systems money, because often behavior and activities that can exacerbate fibrogenesis (ie.: alcohol or pharmaceutical drug consumption, poor diet, etc.) can be modified or avoided with up-to-date information about the state of your liver health.
I am getting a biopsy the 28th, also my gallbladder taken out. My Doc is going to use a DaVinci Robot to remove the bladder and take the biopsy, The thing is they also have a cam looking inside you and the Doc can actually see the placement of the biopsy needle and can Cherry Pick the Fibrosis latin areas www.youtube.com/watch?v=qbqpgPDjCM4
Hi Malcolm:
In the US biopsies are often performed by physician assistants. I was shocked when I arrived at the hospital for my biopsy and learned, as I was lying on the gurney ready to be wheeled in, that the guy performing the biopsy had never spent a day in medical school. I doubt if many patients would have noticed or questioned this; they simply would not have known.
When I expressed my concerns the PA offered to have a physician perform the procedure. He found a licensed doctor. Long story short it wasn't a pleasant experience nor was it an accurate sampling/reading of my fibrosis. I later wished I would have let the P.A. do it. :)
Hard to view biopsies as a gold standard here in the US when they are often not even performed by well trained physicians.
By contrast, fibroscans (at least for now) are generally being done by Hepatologists or GIs with hepatology training and experience, who work in GI/Hepatology Centers.
Well, the FDA and their clinical trials and the AASLD liver experts all say it has 95% reproducibility and they recommend it over biopsies. Also, it is known that fibrosis is generated in areas of inflammatory infiltrate, and that does not occur homogeneously throughout the tissues.
I may be biased but I only had one biopsy and I bled out. Three units of blood later and I bled those out. Then two units of blood later they told me that if they didn't hold they were going in with the rib stretchers. I said, "If these don't hold I'm going out the fire escape!"
Luckily they did hold that time, but I think it is just a little hazardous to give biopsies to people who have clotting problems due to chronic liver disease.
Mike
I am a big fan of Fibroscan. However, it has limitations. These machines are fairly cheap, and operators should be fully trained and be able to produce replicable measurements. Many XRay practices here now have Fibroscan added on as an App. to the regular machines. I know some Sonographers have trouble obtaining the 10+ valid measurements required.
The Fibroscan reading may be high in fatty liver , obese patients and patients who have not fasted for 2-4 hours. Although the newer XL probes are claimed to be more accurate in obese patients ( BMI >30), this is uncertain. The reading is raised in inflammation, particularly during an acute flare.
The mid-range readings ( between 7 and 12 kPa) are unreliable, and Fibrosis stages may vary by one or two stages.
Liver biopsy remains the Gold Standard, although many say 'Imperfect G.S.' Some patients have bad experiences, and many don't like the idea of having a needle stuck into the liver.
When biopsies are done in a large hospital, they are usually done by a junior doctor. Doing a long list of biopsies is bloody boring! The patient doesn't get a thorough explanation, the anaesthesia is not adequate, and sometimes the biopsy samples are difficult to interpret by the Pathologist. A good sample should be at least 3 cms. long, and contain at least 10 portal tracts. Two, ideally 3 samples should be obtained from the R liver lobe.
The advantage of a biopsy is that additional diseases ( like haemochromatosis) will be identified. The amount of fatty infiltration is obvious, not guessed at. The amount of portal tract and centri-lobular inflammation is easy to see. The degree of fibrosis is obvious, and septae or fibrous bands can be counted and measured for thickness. Regenerating nodules are also easy to see.
It is correct that biopsy only samples a small area of liver. Usually, HepC changes are diffuse so this doesn't matter. However it is possible that the area sampled may have more severe or less severe changes. This is why a +/- one stage is considered, unless the patient is cirrhotic.
I think a biopsy should be done initially, then the results monitored by Fibroscan. Just my thoughts. Cheers.
I like the fact that the area that the FibroScan tests is 100 times bigger than the area that the biopsy tests. Also, the fact that ten FibroScan shots are averaged; it is clear that any variation in correlation is on the biopsy side, not the FibroScan's. Monitoring twice a year will be great as well instead of waiting every 3-5 years for a biopsy.
The one thing that many of us HCV patients desperately want to know is what is my fibrosis stage? Liver enzyme blood tests are not relevant to fibrosis staging; neither are Viral Load tests. The only thing that really matters is fibrosis staging, and now we can do it safely and frequently, without fear of bleeding out (that's what happened to me in my one and only biopsy).
I am stoked with the news, and I have already had my FibroScan last week in Scottsdale!
Mike
Hi All,
Found a link for finding where the FibroScan machines are in the U.S.
http://www.fibroscan502touch.com/home
Go to the Find a facility on the right of the page and click
Then click on your state to find if there is one near you. Note: When I saw the blank map, I thought there weren't any until I clinked on my state. I am not the brighteset star in the heavens.
SuziQ
Good to know that insurance plans will soon be covering fibroscans. Just wanted to add that, in the meantime, if you are able to pay out-of-pocket some medical providers will give you a cash discount that usually ranges from 10-25% off.
My last fibroscan, which was in the US, cost $300 cash. I'm not sure if that included a cash discount or not. In Canada my fibroscan cost about $450 USD (for a US citizen).
Thanks, Mike.
Not a question, but just an update on the FibroScan technology in the US which is a non-invasive method to measure fibrosis staging (replacing the needle biopsy). In 2013 the FDA approved the FibroScan technology and in 2014 the AASLD endorsed the FibroScan technology. The FibroScan is technically called Vibration Controlled Transient Elastography (VCTE) and it measures liver stiffness that correlates with liver fibrosis staging. This new technology is replacing the needle biopsy and the advantages are that the procedure in non-invasive, painless, requires no hospitalization and all major insurance plans will soon cover two FibroScans per year. The scans are relatively inexpensive for those who are not covered - about $350 is the going rate. Private medical institutions have bought most of the machines but a couple independent private clinics have opened up in Phoenix and Los Angeles.
Regular live monitoring is very important for liver disease patients and the FibroScan technology will also save the health care systems money, because often behavior and activities that can exacerbate fibrogenesis (ie.: alcohol or pharmaceutical drug consumption, poor diet, etc.) can be modified or avoided with up-to-date information about the state of your liver health.
Best regards!
Mike