Biopsy Questions

Earlier this year in Jan. I had a biopsy done. It was after I complained of RUQ pain and had abnormal blood tests. My ALP was slightly elevated at the time, + AMA's, C-RP & AFP both slightly elevated, and an US showing hepatomegaly (moderate enlargement of the right lobe). On follow-up my Dr. said I had 30% fatty liver, no inflammation and/or damage and my ALP was back to normal. I recently requested and received the written pathology report of my biopsy. It states at the top: question for PBC vs NAFLD. It also states mild steatosis ( lg droplet steatosis) 5-33%, fibrosis stage 0, no portal florid duct lesions or granulomas (portal inflammation: focal and minimal), lobular necroinflammation (minimal, focal 2). It also goes on to say negative biopsy can't exclude the possibility of early stage PBC, clinical follow-up with repeat AMA serology would be appreciated. I did ask my GP for a repeat of the AMA test a few months after the biopsy and again it was +. I know anything over 5-10% is considered fatty, but there's nothing that actually says 30%, it just gives the range. However, there sounds like there is a small amount of inflammation and my liver enzymes have been up and down since May, and at least one enzyme has been elevated on each test. I don't see the Hepa Dr. until Jan. and I'll see my GP in late Oct. Any thoughts on what they'll want do next, if anything? Will I probably end up getting another biopsy?

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11 Replies

  • No, I doubt they'll want another biopsy as they've already diagnosed the problem. I imagine they've told you it's probably due to lifestyle and given you the appropriate advice about diet and alcohol. I expect they'll just monitor your bloods until thinks get better.

  • My GP was the one who mentioned another possible biopsy, because the report stated it couldn't exclude possible early stage PBC.

  • There's your answer then! Sorry did I miss something?

  • I did mention the exclusion part, but not what the GP said. He said a couple of things that had made me wonder and he had also mentioned the AFP marker, but how important is that marker. I just figured it was elevated due to the liver being fatty. I didn't know if they'd go by the ALP being high, more so than the ALT, and AST as to whether they'd do another biopsy. I don't particularly want one and would prefer to have a fibroscan if that were to come up. I know a high ALP is more consistent with cholestatic liver disease such as PBC than NAFLD. Im due for a blood test in the next few weeks hopefully my enzymes have dipped back down into normal.

  • No they're not nice at all. I think only the Dr's can answer your question, but the way to look at it is that if you need one it's for the best and if not it's a bonus.

    I've got one lined up for November, I took part in a medical trial after having a transplant. I hate them too, I've had some really nasty ones that have hurt like ****!!!

    I know when it comes I'll be regretting ever having taken part!

  • Hi Jean - there are so many blood tests with acronyms starting with A - can you confirm that you have an elevated AFP (as you say above) .. thats alpha-fetoprotein blood test .. not ALP AST or ALT.

    You ask how important the AFP is, its different to the ALP/AST/ALT which are essentially liver enzymes used to measure liver and or bile duct inflammation. AFP is a screening test used for liver cancer. Did you definitely have that tested and what was the elevated result you mention.

    From your biopsy it sounds like they have found fat in your liver tissue but not got a definite diagnosis, ie they are not sure if its Non Alcoholic Fatty Liver or that there might be signs of PBC. There's no magic treatment for NAFLD, its up to you to try and work out if there are lifestyle changes that would help. So I would guess the docs might pursue this line of action first, as its the simplest one to start with. If nothing changes, they might repeat the autoimmune blood tests to see if they come back positive for PBC and then maybe try you on PBC medication to see if it alters your blood test results. Do you have high bilrubin and itching which seem to be classic symptoms of PBC but not NAFLD.

    I cant see that doing another biopsy this soon would add anything to the mix, unless they get a completely different piece of tissue with completely different results, but I would guess they might try you on PBC meds rather than go for an invasive procedure.

  • Yes, one of those tests was the Alpha Feta Protein test and it was just slightly high. I think it was 10 with high range of 8.3. So not too much, but the Dr. seemed to act like it held some significance. I was a little dumbfounded as to why he said there was 30% fat, but the pathology report doesn't say that necessarily. I guess that may be splitting hairs ..but

  • It would be wise to have the docs keep an eye on the AFP and check in a month or so that it has not gone higher. Ideally you should have zero (usually shown as <1 on test results). Mine went to double figures and I had a 1cm tumour. It went back to zero when the tumour was removed.

    With the biopsy, remember they take only a tiny sliver which is good for diagnosing a disease but may give a different result to a overall picture of your liver via something like ultrasound. My labs range is 0-10.

  • Oh wow, I was of the idea it had to be kinda of high if there were any kind of tumor. Was it a benign tumor or a malignancy? Did they find it with an ultrasound?

  • I know. If you read the literature it says don't worry til it's up in the 100s. Luckily my GP ignored that and I had a CT which wasn't detailed enough to diagnose and then an MRI which did diagnose HCC. In the one month between the MRI and surgery it almost doubled in size.

  • Thanks, RodeoJoe for taking the time to respond. Good luck with your biopsy and the medical trial. Wishing you all the best and good health, my friend!😊

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