Biopsy results

[elenaki]

Finally have my liver biopsy results. No fibrossis, No NASH just very mild fatty liver and mild inflammation. Dr believes that i do not have an enlarged liver and spleen as suggested by ultrasound. Ct showed normal size. He said the size ranges of a liver, used as a guidline, are based on an average of 100 females and that I am not your average female due to being 181 cms tall, so it would be normal to have a slightly larger liver than other women. My fibroscan (result of 9.6 which was suggestive of fibrossis ) has overestimated my liver stiffness. Dr said that if you are in early stages of liver disease, fibroscan does not give accurate readings.

Biopsy showed mild focal cronic inflammation and mild steatosis with random distribution approximately 5% , grade 1.

No ballooning degeneration (means no Nash), no large or small cell change and no perisinusoidal fibrosis.

METAVIR SCORE

Activity grade A1 ( mild IH grade 1, lobular grade 0 )

Fibrossis stage F0 ( No portal fibrossis)

SCHEUER SCORE

Portal activity 2

Lobular activity 1

Fibrossis 0

NAFLD ACTIVITY SCORE

Activity score 2

(steotosis 1, lobular inflammation 1, ballooning 0 )

Fibrosis staging 0

Diagnosis was Mild portal and lobular inflammation and bile duct inflammation due to very mild steatosis.

Dr said upto 5% fat on your liver is ok to have and that most people do have some fat on their liver.

No further appointments are necessary and i do not need to take vitamin E as advised by the dr before i had the biopsy, because i do not have Nash.

Glucose tolerance tests showed no diabeties, and no insullin resistance.

[Hidden]

Afternoon

Congrats of you Liver issues not being life threatening.

Inflammation will make the Liver appear stiffer on the Fibroscan up to about 2kpa, so taking that into account your Fibroscan would be about 7.6kpa (mild damage) which is inline with the biopsy etc. The Fibroscan covers a much larger area than a biopsy, 1/500th compared to 1/50000th in a biopsy.

So what is causing the fat? diet or booze?

[elenaki in reply to Hidden]

Diet. After the fibroscan, i lost 17 kilos,before having the biopsy. This may have possibly reversed some of the damage.

[Nhaamor51]

I recently had my first Fibroscan done about a month ago. Was told by the nurse practitioner that I had stage 4 liver disease and considering we believe it is due to sarcoidosis that there was no treatment available. She said that there is always a liver transplant when it becomes necessary. I only just met this person five minutes before and she was handing a very dismal prognosis. I immediate got in touch with my Gastro doc and went into his office. He was also very surprised at the results. The last real biopsy showed just SArcoid granuloma. I ended up having a laporoscopy to allow a surgeon to visualize my liver and take multiple biopsies. I have not read the official results but was told that it showed some inflammatory changes with very mild fatty disease. The surgeon said that maybe stage 1-2 liver disease. No cirrhosis seen. Ya.... but I'm sure you know how I was feeling after that fibroscan diagnosis. It was one of the worse times of my life. I cannot believe that test can be so far off that it diagnosis stage 4 disease when in reality it's no where close. To say that it isn't as accurate in early liver disease is even worse. If one cannot count on adequate reliability no matter what stage liver disease you have then how can they be willing to have this be a test they claim can replace liver biopsy. To think of the different kinds of medicine that would have been prescribed because of that test really scares me.

As an afterthought: I have had several different types of scans and blood work. It seems as soon as they are sure about an accurate diagnosis another result comes in that contradicts the last one. So I feel like I'm left in an even bigger dilemma of trying to figure out which test results to believe.

[Hidden in reply to Nhaamor51]

Its a measure of stiffness that is then translated into the likely level of scaring. Your condition is pretty unusual and its worth keeping in mind that a biopsy has a 30% chance of a false negative in Hep c suffers for instance. The Fibroscan is a very good test and it chances of a false negative are nearly none. What you are talking about is a false positive which can be due to inflammation and things like your rare condition.

[Nhaamor51]

The biopsy showed inflammatory changes but don't most liver conditions have this in common. So which test do I use to drive treatment decisions? The constant pain I feel with episodes of severe pain correlate with very high liver enzymes and alk phos. After an acute attack the labs do go down never what might be considered normal but also not 800. Maybe I should split the difference and go from there. It just feels like the more testing that's done the more questions I have. Thanks for the info. I really have no knowledge of this test and its accuracy. I was wondering if maybe she needed to recalibrate her machine or something.

[Az_lady]

Congratulations! It is so wonderful to get happy results after all The worrying that we do ! 🎉🎈

Pat ☺️