3 years ago I was diagnosed with cirrhosis 4 with advanced fatty liver. This was determined by blood test and fibroscan. I went for 2nd opinion, new doctor didn't believe I had cirrhosis so suggested biopsy which showed Stage 1 mild fibrosis with mild fatty liver zone 3. This Doctor also did not believe in the fibroscan and didn't use it. After biopsy he had me have a couple blood test and an ultrasound every year looking for tumor. He left and I now have a new gastroligist, this year was first time with him. I had the blood work and US everything good. I have every 3 months blood work by primary, everything great nothing high. So my brand new doctor had me have a series of his own blood test he said it was all great. Now he is sending me for the fibrotest-actitest panel. I don't trust blood test since they always showed cirrhosis in the past. Does anyone know this test, what is it, how reliable is it, is it new? Is there a better test to check for fibrosis, he said this is why he is requesting it, just routine only. I don't trust anything that uses blood numbers for algorithm type testing I feel for good reason. Thanks
Fibrotest-actitest panel: 3 years ago I... - Living with Fatty...
Fibrotest-actitest panel
What you need is an MRE (magnetic resonance elastography) to accurately measure the fibrosis level of your liver. It's as accurate as a biopsy and way more accurate than Fibroscan, which itself is more accurate than an ultrasound.
If you feel like it may give you an inaccurate reading, for whatever reason, just don't get the bloodwork, or ask for a different test. Do you have some reason to believe things may have took a turn for the worse?
No, but blood work always showed cirrhosis 4 or indeterminate, that's why I had the biopsy. I haven't had any problems and all markers have been good. He's new to me and I guess he just wanted to do this test.
How could they say you had mild fatty liver and cirrhosis at the same time? They're at opposite ends of the spectrum.
Blood test showed cirrhosis 4 with advanced fatty liver. Biopsy showed Stage 1 mild fibrosis with mild fatty liver zone 3.
A biospy only samples a small area of the liver. I assume the blood test you are referring to is the fib 4 test. I would ask for a MRE which tests your entire liver for fat and fibrosis
Thanks, the FIB-4 I had it was indeterminate several years ago before biopsy. I had the biopsy because it was the best I was told at the time. However, all the blood test this time, he had run along with my regular 3 month blood work, he would have had all the information to do the FIB-4. So I don't get why he would be sending me for this panel, the others were in April. He wrote and said those were all good but he wanted me to go in and have this blood drawn for this test. Very confusing, I just don't trust blood test and algorithm. I would prefer the MRE but I assume it's more expensive and maybe Medicare has a process, I don't know guess it wouldn't hurt to call his office altho I never get to speak to him.
I just had a Mre and it was covered by Medicare. I don't trust fibroscans. My latest Mre showed no fat or fibrosis. I was diagnosed with stage 3 nash in March 2023.
Thank you. I just sent a portal message asking why he was suggesting this test and my concerns along with a brief rundown of my past and suggesting the MRE. I agree with you on the fiboscan nor the blood test and using algorithms. Even tho he took over my previous doctors patients and he seems nice, I DO NOT feel he has read my past records. The prior Doctor when I requested a 2nd opinion pulled and read my records as far back as they went, I was so impressed with him then he moved out of State, bummed!!
I'm fairly new to this. What are zones?
I had no idea either so I looked it up finding zone 3 is the area most affected by acetaminophen, which by looking at it is way away from the area they took the biopsy. My question was, how do you know it's zone 3 when it's so far away from the extraction point. That was never answered altho the PA said it was a good question.
Hi Deb
Those blood tests are useful as guides but aren't normally diagnostic by themselves. They are 85 to 90 percent as good as biopsy, but remember that biopsy has an error rate which has been shown to be as much as 20% in some studies. MRE has the best record to date with accuracy of 90 to 95 percent.
Thanks Wayne. I told him I'd prefer that test. I did go and have the blood test done today. Guess we will see what it says, I just fear going through all that 'scariness' again if it indicates the levels they have before....
Hi WayneAfter thinking and reading about this test. Altho I can't remember the name of the test but we were only able to get it by paying ourselves. I believe it was $200, I had it done through Quest Labs it told the level of fibrosis/cirrhosis, fatty level and where progression was. I know you also had it done several times, is this test and the fibrotest- actitest the same or similar? Thanks
I did the Liverfast test. It is a direct competitor. Both of them provide similar information. Interestingly, both were developed and tested against the same datasets that FibroScan was originally certified under
"MRE has the best record to date with accuracy of 90 to 95 percent."
Do you refer to this accuracy definition?
"The accuracy of a diagnostic test is defined as how often the test correctly classifies someone as having or not having the disease. The formula for accuracy is:
(true positive + true negative) / (true positive + true negative + false positive + false negative)or correct results / all results"
Do you maybe have sensitivity (ability to correctly identify the ill) and specificity (ability to correctly identify the well) of MRE?
"The purpose of a diagnostic test is to distinguish the ill from the well. In that sense, a test has 2 roles:
to correctly identify the ill and
to correctly identify the well
The appropriate metrics for these two functions are sensitivity (ability to correctly identify the ill) and specificity (ability to correctly identify the well)."
In other words MRE is better to confirm cirrhosis or to exclude it?
Thank you
That is the formal definition. There are actually values calculated for each measure. Patients rarely engage a discussion of the entire issue so we think of it broadly. Remember that it is calculated relative to biopsy which has its own error rate so an actual value is the two multiplied together. That demonstrates that the only true diagnosis is at autopsy.
Hi Wayne, just got the results today.
So the chemistry says that at a minimum you are at risk of advancing fibrosis. It isn't proof but can be viewed as a probability and your doc will consider it in conjunction with all of your other data. All of these tests can produce false positives and negatives, particularly in the intermediate zone.
