Aa
Biopsy
When a biopsy is performed on the liver how accurate are the results? Does the one area of tissue taken speak for the rest of the organ? Or is it possible there could be further damage to another area of the liver? (or less damage)
I'm doubtful about so-called liver pain because the liver has no nerve endings and because of my own experience, of being close to death from liver cirrhosis and never feeling pain in that area.
The fact you bruised from the biopsy has nothing to do with the liver itself.
Many things can cause the area of the liver to feel pain, including digestive issues, gall bladder problems, the pancreas, and more. Hector says the liver can radiate pain, so I belive him.
I've had three biopsies, all were a simple needle incision between my ribs. It's removed a small but long sliver of the liver. The pathologist is looking at tiny things, liver cells. So it's easy to imagine the pathologist dividing the sample into mutliple sections to examine.
Biopsies normally give an accurate idea of your liver's condition, especially if done and read by experienced reliable professionals.
I trust my hepatologist and he trusts the pathologist, which is good enough for me.
Finding a good doctor is paramount, in my opinion.
The fact you bruised from the biopsy has nothing to do with the liver itself.
Many things can cause the area of the liver to feel pain, including digestive issues, gall bladder problems, the pancreas, and more. Hector says the liver can radiate pain, so I belive him.
I've had three biopsies, all were a simple needle incision between my ribs. It's removed a small but long sliver of the liver. The pathologist is looking at tiny things, liver cells. So it's easy to imagine the pathologist dividing the sample into mutliple sections to examine.
Biopsies normally give an accurate idea of your liver's condition, especially if done and read by experienced reliable professionals.
I trust my hepatologist and he trusts the pathologist, which is good enough for me.
Finding a good doctor is paramount, in my opinion.
I assumed by the one entry (where I bruised) that they only took one sample from that particular area. Thanks for the input I will ask about this. The reason for my concern is the degree of pain I have in a different area of the liver as opposed to the area I thought the sample was taken. (More pain in area I didn't think they took sample)
Did you have more than one incision or whatever you call it when they took 3 tissue samples? I didn't ask many questions because my anxiety was incredible after learning about Hep C and was unable to handle it well at the time.I am getting better about it now; just keeping faith.
Did you have more than one incision or whatever you call it when they took 3 tissue samples? I didn't ask many questions because my anxiety was incredible after learning about Hep C and was unable to handle it well at the time.I am getting better about it now; just keeping faith.
Sampling error and intraobserver variation in liver biopsy in patients with chronic HCV infection.
Regev A, Berho M, Jeffers LJ, Milikowski C, Molina EG, Pyrsopoulos NT, Feng ZZ, Reddy KR, Schiff ER.
SourceDivision of Hepatology, Center for Liver Diseases, University of Miami School of Medicine, Florida 33136, USA.
Abstract
OBJECTIVES: Needle liver biopsy has been shown to have a high rate of sampling error in patients with diffuse parenchymal liver diseases. In these cases, the sample of liver tissue does not reflect the true degree of inflammation, fibrosis, or cirrhosis, despite an adequate sample size. The aim of this study was to determine the rate and extent of sampling error in patients with chronic hepatitis C virus infection, and to assess the intraobserver variation with the commonly used scoring system proposed by Scheuer and modified by Batts and Ludwig.
METHODS: A total of 124 patients with chronic hepatitis C virus infection underwent simultaneous laparoscopy-guided biopsies of the right and left hepatic lobes. Formalin-fixed paraffin-embedded sections were stained with hematoxylin and eosin and with trichrome. The slides were blindly coded and randomly divided among two hepatopathologists. Inflammation and fibrosis were scored according to the standard grading (inflammation) and staging (fibrosis) method based on the modified Scheuer system. Following the interpretation, the slides were uncoded to compare the results of the right and left lobes. Fifty of the samples were blindly resubmitted to each of the pathologists to determine the intraobserver variation.
RESULTS: Thirty of 124 patients (24.2%) had a difference of at least one grade, and 41 of 124 patients (33.1%) had a difference of at least one stage between the right and left lobes. In 18 patients (14.5%), interpretation of cirrhosis was given in one lobe, whereas stage 3 fibrosis was given in the other. A difference of two stages or two grades was found in only three (2.4%) and two (1.6%) patients, respectively. Of the 50 samples that were examined twice, the grading by each pathologist on the second examination differed from the first examination in 0% and 4%, and the staging differed in 6% and 10%, respectively. All observed variations were of one grade or one stage.
CONCLUSIONS: Liver biopsy samples taken from the right and left hepatic lobes differed in histological grading and staging in a large proportion of chronic hepatitis C virus patients; however, differences of more than one stage or grade were uncommon. A sampling error may have led to underdiagnosis of cirrhosis in 14.5% of the patients. These differences could not be attributed to intraobserver variation, which appeared to be low.
http://www.ncbi.nlm.nih.gov/pubmed/12385448
Regev A, Berho M, Jeffers LJ, Milikowski C, Molina EG, Pyrsopoulos NT, Feng ZZ, Reddy KR, Schiff ER.
SourceDivision of Hepatology, Center for Liver Diseases, University of Miami School of Medicine, Florida 33136, USA.
Abstract
OBJECTIVES: Needle liver biopsy has been shown to have a high rate of sampling error in patients with diffuse parenchymal liver diseases. In these cases, the sample of liver tissue does not reflect the true degree of inflammation, fibrosis, or cirrhosis, despite an adequate sample size. The aim of this study was to determine the rate and extent of sampling error in patients with chronic hepatitis C virus infection, and to assess the intraobserver variation with the commonly used scoring system proposed by Scheuer and modified by Batts and Ludwig.
METHODS: A total of 124 patients with chronic hepatitis C virus infection underwent simultaneous laparoscopy-guided biopsies of the right and left hepatic lobes. Formalin-fixed paraffin-embedded sections were stained with hematoxylin and eosin and with trichrome. The slides were blindly coded and randomly divided among two hepatopathologists. Inflammation and fibrosis were scored according to the standard grading (inflammation) and staging (fibrosis) method based on the modified Scheuer system. Following the interpretation, the slides were uncoded to compare the results of the right and left lobes. Fifty of the samples were blindly resubmitted to each of the pathologists to determine the intraobserver variation.
RESULTS: Thirty of 124 patients (24.2%) had a difference of at least one grade, and 41 of 124 patients (33.1%) had a difference of at least one stage between the right and left lobes. In 18 patients (14.5%), interpretation of cirrhosis was given in one lobe, whereas stage 3 fibrosis was given in the other. A difference of two stages or two grades was found in only three (2.4%) and two (1.6%) patients, respectively. Of the 50 samples that were examined twice, the grading by each pathologist on the second examination differed from the first examination in 0% and 4%, and the staging differed in 6% and 10%, respectively. All observed variations were of one grade or one stage.
CONCLUSIONS: Liver biopsy samples taken from the right and left hepatic lobes differed in histological grading and staging in a large proportion of chronic hepatitis C virus patients; however, differences of more than one stage or grade were uncommon. A sampling error may have led to underdiagnosis of cirrhosis in 14.5% of the patients. These differences could not be attributed to intraobserver variation, which appeared to be low.
http://www.ncbi.nlm.nih.gov/pubmed/12385448
Good info from will and hector
Yes, there can be differences in damage in different parts of your liver but, as nygirl says, the technitions do get samples from different areas.
Yes, there can be differences in damage in different parts of your liver but, as nygirl says, the technitions do get samples from different areas.
I believe most doctors take several samples and hopefully that gives us the full picture, I know my doctor took three.
Thank you for responses. I am wondering if a biopsy of a different area of my liver could show a different stage than the area tested? I was informed that any tissue of liver would be the same in the rest of liver.... at least as far as measuring fibrosis. Anyone have any info or experience with this?
In addition to what Will has said I would like to add that like all tests, the doctor performing the biopsy must follow proper procedures for the results to as accurate as possible and minimize sampling errors. Even so-called easy, basic blood draws must be done in the proper fashion or the results will not be valid.
From the AASLD Position Paper written for doctors which contains the best practices and standards for liver biopsy used in the fields of gastroenterology and hepatology.
Recommendations
25. Because diagnosis, grading, and staging of nonneoplastic, diffuse parenchymal liver disease is dependent on an adequate sized biopsy, a biopsy of at least 2-3 cm in length and 16-gauge in caliber is recommended.
26. It is recommended that if applicable, the presence of fewer than 11 complete portal tracts be noted in the pathology report, with recognition that diagnosis, grading, and staging may be incorrect due to an
insufficient sample size).
27. If cirrhosis is suspected, a cutting rather than a suction needle is recommended.
28. In clinical practice, use of a simple (e.g., Metavir or Batts-Ludwig) rather than complex (e.g., Ishak) scoring system is recommended.
http://www.aasld.org/practiceguidelines/Documents/Bookmarked%20Practice%20Guidelines/Liver%20Biopsy.pdf
So while sampling errors still do exist, liver biopsy is still the gold standard for assessing liver disease.
Cheers!
Hector
From the AASLD Position Paper written for doctors which contains the best practices and standards for liver biopsy used in the fields of gastroenterology and hepatology.
Recommendations
25. Because diagnosis, grading, and staging of nonneoplastic, diffuse parenchymal liver disease is dependent on an adequate sized biopsy, a biopsy of at least 2-3 cm in length and 16-gauge in caliber is recommended.
26. It is recommended that if applicable, the presence of fewer than 11 complete portal tracts be noted in the pathology report, with recognition that diagnosis, grading, and staging may be incorrect due to an
insufficient sample size).
27. If cirrhosis is suspected, a cutting rather than a suction needle is recommended.
28. In clinical practice, use of a simple (e.g., Metavir or Batts-Ludwig) rather than complex (e.g., Ishak) scoring system is recommended.
http://www.aasld.org/practiceguidelines/Documents/Bookmarked%20Practice%20Guidelines/Liver%20Biopsy.pdf
So while sampling errors still do exist, liver biopsy is still the gold standard for assessing liver disease.
Cheers!
Hector
Liver biopsy ,like all fibrosis markers ie.(fibroscan and /or fibrosure blood tests) are prone to some degree of error ,however the biopsy is still considered an excellent prognosticator of liver damage. (article below)
Best..
Will
The quest for accurate non - invasive tests is ongoing ,and it seems many Hepatologists have differing opinions. There are many articles on the pluses and minusus of all fibrosis testing (fibrosure.MRE,Fibroscan and biopsy) All tests are prone to some % of error
.http://www.sciencedaily.com/releases/2011/06/110602121706.htm
Imaging techniques such as ultrasound-based transient elastography (TE) and magnetic resonance elastography (MRE) are noninvasive procedures that measure liver stiffness. Prior studies have found TE to be up to 90% accurate in diagnosing cirrhosis, and 70%-80% accurate in detecting stage 2 to stage 4 fibrosis. Evaluations of MRE have shown up to 85% accuracy for detecting intermediate to severe fibrosis (F2-F4). Currently only MRE is approved for use in the U.S.
"Noninvasive diagnostics are more advantageous to the patient as there are no serious side effects and they may be more cost effective when compared to liver biopsy although this remains to be determined," Dr. Talwalkar concluded. "Fibrotest or elastography imaging are helpful to confirm cirrhosis or minimal to no fibrosis. Liver biopsy may still be necessary to determine stage of fibrosis in those patients where noninvasive techniques were indeterminate."
Best..
Will
The quest for accurate non - invasive tests is ongoing ,and it seems many Hepatologists have differing opinions. There are many articles on the pluses and minusus of all fibrosis testing (fibrosure.MRE,Fibroscan and biopsy) All tests are prone to some % of error
.http://www.sciencedaily.com/releases/2011/06/110602121706.htm
Imaging techniques such as ultrasound-based transient elastography (TE) and magnetic resonance elastography (MRE) are noninvasive procedures that measure liver stiffness. Prior studies have found TE to be up to 90% accurate in diagnosing cirrhosis, and 70%-80% accurate in detecting stage 2 to stage 4 fibrosis. Evaluations of MRE have shown up to 85% accuracy for detecting intermediate to severe fibrosis (F2-F4). Currently only MRE is approved for use in the U.S.
"Noninvasive diagnostics are more advantageous to the patient as there are no serious side effects and they may be more cost effective when compared to liver biopsy although this remains to be determined," Dr. Talwalkar concluded. "Fibrotest or elastography imaging are helpful to confirm cirrhosis or minimal to no fibrosis. Liver biopsy may still be necessary to determine stage of fibrosis in those patients where noninvasive techniques were indeterminate."
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