Liver Biopsy

[keepin15]

I had abdominal ultrasound and it was unremarkable for my liver, gallbladder and kidneys but my doctor now wants me to do the liver biopsy. My ALP (234), ANA (1:160 nuckeolar), AMA (equivocal) and ASMA (25) a weak positive but everything else was normal. My question is could I still have PBC even with a unremarkable ultrasound or is it just real early stage with no symptoms? I'm just confused right now and skeptical about the biopsy.

[donna01]

Do they have fibroscan where you live? Google hospitals in your area that offer it. I would go with the fibroscan quite honestly versus the biopsy, but that's just me

[PBCRobert Partner]

Hi,

My first question is "Why?" Why does the Dr want to do the biopsy? You have +AMA and raised Alk Phos which would be enough to diagnose PBC according to EASL guidelines.

Second question is "Where in the world are you?" There are different protocols followed in different countries, none of which should stop you from having best clinical practice.

Last question is "Have you joined the Foundation and accessed their information?" I am sure it can help, particularly the compendium and the lay version of the EASL guidelines on PBC.

Yours, as ever,

Robert.

[gwillistexas in reply to PBCRobert]

Robert, did you by chance see this information from the Roundtable discussion that Donna w/ALF attended in Houston?

Biopsy - 1/50,000 of liver taken from biopsy

1/500 of liver scanned with fibroscan

100% of liver is seen with MRE

[PBCRobert Partner in reply to gwillistexas]

I knew that but thank you.

[My-life in reply to gwillistexas]

Blessings.

[Ktltel]

Keepin15,

Here in Kansas USA, the protocol is Ultrasound and then biopsy too. But I've since then learned that an ultrasound doesn't really show fibrosis from PBC. Some on this site have had ultrasounds which came back fine, and went on to have a Fibroscan which then showed otherwise. ☹️ Sad but true.

My hepatologist is still making me have ultrasounds every 6 months. I was diagnosed with PBC on having an elavated AMAM2 and elavated Alk-phos alone. Then he did have me get a biopsy too. Again, not the best tool for the job. This is because the liver is a large organ. A biopsy takes a sample from one general area. What if the disease is manifesting itself on a different area of your liver? Exactly, it would go undetected until things got worse. I've learned from this site that asking for a Fibroscan is the way to go. Or both. My doctor was good about having both done.

Let us know how it goes. Your numbers are up there a little bit. The medication for PBC is called Ursodiol or URSO. My doctor started me on it right away. It really has helped many to bring those numbers down. Unfortunately for me, my numbers have fluctuated up and down within 20 points for 2 years. I do better when I lose weight. I'm having issues with that right now. Or, I should say I'm working on that right now. ❤

Nice to meet you 🙋. Again, please let us know how it goes.

Stella ❤

[Ballymahon2]

Sounds like you have pbc

[Hidden]

i have normal liver readings since taking urso and have had a fibroscan as i believe its more accurate and a lot less invasive than a biospsy try and get a fibroscan even if means travelling abit but thats only if your health authority will take it on im in birmingham QE

[Jmorrison]

Are you with a liver specialist or just a gp? It took a biopsy to diagnose my pbc but I had had abnormal liver function tests for a long time and wasn't functioning well due to fatgue so I knew something was wrong.

[ninjagirlwebb]

My sonogram was unremarkable as well but I have pbc. I didn't listen to the first gastroentrologist to have a biopsy. I could have been diagnosed 4 years earlier. Later another doctor, a hepatologist convinced me to do a biopsy. I should have done the biopsy earlier. But that was me not familar with any of this.

[GrittyReads]

Ultrasound does not show the liver tissue at a microscopic level, which is what is required if PBC is to be detected. Ultrasound can only show the marks of mass scarring/cirrhosis over the liver tissue, which would be expected only in advanced PBC, or with other with liver damaging conditions (eg including the scarring/cirrhosis from long-term alcohol abuse, which is not at all the question here). A biopsy looks at small samples of liver tissue at a microscopic level, and can see the damage to the minute biliary tubules that PBC attacks. Yes, there is a risk that the samples taken in biopsy will miss the regions of the liver where there is PBC, but you can have a fibroscan if further assessment is needed. However, as your results do suggest PBC, even if AMA is slight (and remember some people have PBC without AMAs being present at all) I would opt for the biopsy.

But do keep coming back here with any questions and worries, and do check out the 'PBC Foundation' as Robert suggests. It is a wonderful up-to-date site, with lovely trained advisors and lots of input from the leading UK PBC specialists; plus ... the summary of the recent official/formal Diagnostic Guidelines that Robert mentions is an excellent document to read and refer to.

Hope this helps and that all goes well.

Gritty

[Miamomma]

For the past three years, I've heard from the endocrinologist , "I don't think a liver biopsy is necessary yet. I have told my endocrinologist that I'm not a fan of a liver biopsy. I'm on Xeralto and am a bleeding risk. I would have found a facility to do a fibroscan. I had an MRI and MRCP two weeks ago and my numbers are down. They have pretty well determined I do not have pbc. My numbers were up due to the massive antibiotics I was administered when I had Sepsis in September/October. The endocrinologist has ordered (waiting for approval of my insurance) an elastography ultrasound. Praying my liver is not stiff so I can be through with this. So tired of the x-rays/ultrasounds/MRI and every other test I have been through...I understand the importance, but I'm tired

[ninjagirlwebb in reply to Miamomma]

I think the antibiotics probably threw your numbers off. Hopefully, it goes back to normal & you are fine.

[Miamomma in reply to ninjagirlwebb]

Thank you!