biopsy misread?

[mbnh]

Three years ago I had a liver biopsy.  I was told I had stage 4 cirrhosis.  I went through Peg/Interferon TX and have been virus free for two years.  I've had ultrasounds for three years, twice a year and one endoscopy.  My new doctor says there have been no signs of cirrhosis on any of the US.  My liver looks great.  Could they have misread the biopsy?  I have never had any symptoms of liver disease.  Only the diagnosis of Hep C.  I'm not complaining, I'm wondering if anyone has had this experience or if cirrhosis just doesn't show up on US.

[mbnh]

thanks for all the information.  I'll be talking to my doctor face-to-face in a couple of weeks and I'll be asking her all of the questions that were brought up in your comments.  One thing she said over the phone is the US would be less frequent now, maybe once a year.  but thanks again, you guys are always so helpful.

[nygirl7]

I agree with FLGuy - both case scenario's could be correct.  I think the only way you could really verify would be another biopsy to concur that your liver damage has regressed.  Either way you do have to continue to follow up but it seems to be just great news for you! That is why we do treatment right?

[FlGuy]

They both could be correct.  Having been virus-free after treatment your liver improves and to the possible extent that it's back to normal.

[merryBe]

I'm inclined to think biopsy isn't the gold standard for a couple of reasons.

1. new evidence suggests a diseased liver can have pockets of advanced disease.
2. not all biopsys take 3 samples.
3. as mentioned above even the reading is somewhat subjective.

the new fibroscans, which are far from perfect as well have brought to the light at least the fact that livers vary in the degree of consistancy of fibrosis. One liver may be evenly fibrotic, while another may have pockets of stage 1,2,3 and 4.
Often one lobe can be more effected than the other...originally it was thought that the fibrosis was more or less consistant across the organ, and that is usually true but not always. It's like saying because most hearts clog at the top valve that all do..not so.

then too...let's say you have the type liver that is not consistant, and the needle hits a tough or scarred area. Your reading would be stage 4...yet you may have more functional tissue than some with stage 3...it all depends...

all you can really do is what Bill suggested, keep an eye on the labs and take care of yourself...none of us know how long we have.

[copyman]

a biopsy is only as good as the pathologist that reads it.

Pathologist = Human = Possible mistake

[Trinity4]

U/S scan can determine if the liver or spleen is enlarged, the diameter as well as flow of the portal vein; it reads the topography of the liver and notes any nodules that can occur with cirrhosis. It's a fairly good test but not usually given specifically to rule out cirrhosis.
You've been virus free for two years so some fibrosis reversal may very well have occurred.

Depending on who is reading the biopsy and from what area the sample was taken results can be off as much as a 1 stage either way.  Like any other test, biopsy isn't always 100% accurate but it's the best we have to determine the exact stage of deterioration in the liver. I'm sure your doctor has done blood tests over the last several years too for things like platelets, bilirubin, INR which also indicate the health of your liver.  So as long as you feel good and your doctor is comfortable with the findings I say enjoy your health and congrats on your SVR.

Trinity

[Bill1954]

Hi there,

It’s possible that the initial biopsy was misread; however, it’s likely you also had blood work that corroborated that diagnosis. Usually, biochemical markers such as platelets and albumin are off enough so that a diagnosis can be made in the absence of evidence from pathology. Did you happen to keep labs from back then? Someone in here might be able to review and help interpret them.

Ultrasound scans aren’t particularly useful for identifying cirrhosis. They can detect frank cirrhosis sometimes if surface nodularity is present, and they can certainly detect organ enlargement, enlarged portal tract along with retrograde flow… these can be associated with cirrhosis.

The U/S scan is good for detecting masses; if you had cirrhosis in the past, you’ll want to continue surveillance for liver cancer. The incidence for HCC, or primary liver cancer is elevated in cirrhotics; and while we can prevent further damage from fibrosis by eliminating the virus, the chances for developing HCC continue. They should also check your AFP every six months as part of this surveillance; this is a blood marker for the same cancer just in case.

Congrats for beating the virus—

Bill