Hep C Discussion Forum

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. 

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.

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