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British Liver Trust
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Biopsy - liver cirhosis

Hello everyone. I just had a biopsy yesterday. It wasn't to painful and was lucky to have a wonderful medical staff around me.

I was just wondering how accurate can be a liver biopsy, if let say the stamp wasn't taken from the most damaged part of the liver. If this is possible? Or maby the fibrosys is formed all around the liver with the same thickness? Or, the doctor can see clearly within just using the ultrasound?

Thank you.

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Thanks for coming back to let us know how it went.

Jim

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You'd have to be unlucky for the biopsy tissue sample not to reflect the overall state of your liver.

Dr. Melissa Palmer's Guide To Hepatitis and Liver Disease:

"Because most liver diseases affect the entire organ uniformly, this tiny sample is usually representative of the entire liver and provides a complete story. It is unlikely that this specimen would look better or worse than the rest of the liver, but it can happen—though very rarely. This uncommon occurrence is known as a sampling error."

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Thank you for the reply. Hopefully I'll be able to know more about my liver condition.

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I was told damage is not necessarily homogenous-( even) across the liver, so it is possible that the sampling does not give a complete picture of damage across the liver. Also, interpretation of the biopsy has been described as more art than science by some of the consultants. At best it is variable between pathologists looking at the results. However, we have been told the biopsy can easily distinguish between fibrosis and cirrhosis.

The ultrasound can indicate cirrhosis, but not always :)

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Thanks for the reply. So, I understand that the biopsy can show fibrosis instead cirrhosis which was shown by the fibroscan?

Thank you

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I have portal hypertension, which would suggest I have cirrhosis. However, my fibroscan score does not support this (the score is low enough to suggest fibrosis). My biopsies again have suggested fibrosis not cirrhosis. My initial consultant when questioned on this said "fibrosis/cirrhosis- it's semantics".

My last consultant actually said we now know that where the scarring occurs is what causes the portal hypertension, which is why we couldn't explain your results and your actual medical issues. However, they only know that it's the placement of the scarring through research done in Germany. This mapping of the liver has been done in Germany, but is not done here. So they don't know for sure where my scarring is, but the conclusion is, that it is in a place that causes the effects of portal hypertension.

Phew! I hope that helps. I'm afraid I can only tell you what my experience has been and what I have understood from that. I hope I explained in a way that makes sense. I have AIH (auto-immune), so this might only hold true for my condition and not others. I honestly don't know :)

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The first consultant actually said " fibrosis/cirrhosis.. symantics"? How ignorant of them lol mild fibrosis and severe cirrhosis are not even close to the same thing. Tbat consultant deserves a boot in the arse. The Germans have the goods! 😊

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To be fair, my consultant (1st) was very good, but short on chit-chat or detailed explanations, unless pressed. He served me well for 8 years, although when he said that I thought hmmm, I need a transfer and better explanations :)

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The consultant which took the biopsy also said fibrosys instead cirrhosis and made me confused. When I asked saed that is the same thing, but she use the word fibrosis because is does not sound as bad as cirrhosis.

I don't understand why they make people so confused 😕..

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My consultant took the approach that it doesn't really make any difference to the treatment that we're giving you. Maybe when they mention cirrhosis, people imagine that they will die soon or something, so they don't want to alarm people. Who knows? :(

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Personally I don't think that what the Consultant told you is wrong or contradictory.

It is my understanding that when a liver biopsy report indicates there is fibrosis then that is allocated a score which is appropriate to the actual level of the fibrosis scarring.

There are various scoring methods and in some a score of 1 to 4 is used while others use a score of 1 to 6. When I had my biopsy to confirm earlier blood tests and imaging results that were indicative of Autoimmune Hepatitis (AIH) the 6 point scoring system was used and unfortunately for me my score was at the higher end 5/6 and was thus fibrosis bordering on cirrhosis. It took a while for the therapeutic treatment of the AIH to kick in and by that time the fibrosis scarring had developed into Cirrhosis and of course when that occurs the scarring is irreversible.

It does seem to be the case, and particularly with AIH, that if an effective treatment plan is put in place (steroids etc) it can slow down its progress or hold it in remission. I also recall reading some research that found if effective treatment can be started when the fibrosis is still in the early stages ( i.e. at the lower end of the scoring systems referred to above) then there is a possibility the fibrosis scarring might be reversed. However as I suggested above when the fibrosis has reached the cirrhosis stage then it is not reversible.

I am not a medical doctor and the above is based on my own experience and research I did when I was first diagnosed ( several years ago) as well as discussions with my own liver doctors etc .

I have outline the above to you just in case it might help to eliminate the confusion you mention and because in my view there is a distinction between the reference to fibrosis and similarly to cirrhosis. It seems to me that what is more relevant to know from a patients perspective is an indication from their doctor about the stage their fibrosis is at when diagnosed. Not all fibrosis is cirrhosis and underlying treatments are probably aimed at halting or delaying its advancement to cirrhosis when it then becomes irreversible.

Regards

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Hello MC1189.

In your to monikoki you have referred to liver mapping done in Germany but not here and I mention the following to you in case it may be of some interest.

During the course of the past 12 to 18 months, I as well as others that subscribe to this forum have attended a Hospital in Oxford where we assisted research into the use of an innovative MRI scanning programme that is hoped might be used as a tool in the diagnosis and analysis of the severity of liver disease instead of biopsy etc. We underwent an initial fairly lengthy MRI scan followed a few months later by multiple MRI scans in different scanners and twice in each one . I think this was to establish that the result was the same regardless of what MRI scanner was used.

I understand that during the process the scanner took photos of various slices of the liver and at the end a coloured analytical report was generated. This revealed illustrations of the various slices of the liver as well as details of the measures of inflammation and fibrosis, the measure of the iron load, the density of fat as well as showing the extent of any ascites surrounding the liver etc. Normal ranges for the above were also shown .

All in all a very colourful and informative report.

Does this sound like it could be the same as or similar to what you say is done in Germany?

I do not know the eventual end outcome of the research and even if good whether this MRI diagnostic procedure will be implemented here. Even if it is then as is often the norm it will probably take ages for necessary approvals .

Regards

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I've just looked at my notes from the meeting we had with the consultant, which says that the research in Germany is done by laparoscopy, so no it is not the same. Theirs is done from the point of view of finding out more about the pattern of scarring and how the position of this scarring results in different outcomes for the patients. I didn't get the impression that it is to be rolled out anywhere.

Our impression was that different centres across the world have their own way of researching the liver and its associated diseases and they don't overlap each other necessarily, since the researchers each have their own point of view of the way forward.

When I looked at the research paper for the u/s work, I discovered that there are 7 different ways of doing a u/s and hence different scoring systems. Maybe there is this level of variation in MRI and they want to see about standardising it more?

Many thanks for your response, it was interesting to see what it being done here :)

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According to a research paper I have just looked at , there are a number of key factors that can affect the reliability of the u/s test. One of these is the fact that not all u/s scans are carried out in the same way. It seems that the technique which uses "assessment of the liver surface" was the most reliable when trying to decide if the patient had severe fibrosis or cirrhosis present. Who knows what technique they use at the hospitals we are examined at. So whilst sampling can also affect the readings, there are many other reasons why people can end up getting different feedback. This paper was published in 2010, but I can't imagine much has changed. :)

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