Your biopsy and what to ask the doctor about your results.

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Dean,

I have looked up some info about biopsies for you. I am not an expert of any kind. But when forming questions to ask your doctor about your results. I would read up on whta the OBJECTIVES and the reasons are for getting a biopsy, think about what it is you want to find out and why. I have selected some reading about what a biopsy is and why to get a biopsy. I hope reading them might help you form your questions to ask the doctor. MAIN thing being get the maximum info out of getting the biopsy. You had to go through a lot to get it, now mkae sure your doctor gets the info they need to help you make informed decisions about your treatment:

International Conference Reporter from 11th World Congress of Gastroenterology (WCOG)

Vienna, Austria

September 10, 1998

Liver biopsy in chronic hepatitis – why do it?

Dr P Scheuer, London, UK, provided strong arguments for the continued use of liver biopsy in diagnosis, pre- and post-treatment assessment, follow up, and research, in chronic hepatitis.

Biopsy adds much to liver function tests in diagnosis, and is essential for total assessment. Although HCV RNA in serum is now often used for diagnosis of Hepatitis C, biopsy can give more insight into the nature of disease, showing extent of inflammation and cirrhosis. Biopsy can also illustrate which disease is responsible for liver damage in cases of e.g. hepatitis plus thalassaemia.

In assessing patients’ need for treatment, biopsy is also useful. Originally, pathologists had difficulty in classifying hepatitis by histology alone, but a number of grading and staging systems have been used over the years. Clinicians require a numerical evaluation to assist their decisions to treat, and the simple algorithm of the METAVIR group has been very useful. This has a range of 0-3, and does not detect minor histological changes. On the other hand, the Knodell updated scoring allows a cumulative grading of 0-18, and a staging of 0-6. However, a ‘grading total’ figure should not be used to assume the need for therapy, since these numbers are not true measurements, but a hierarchy of gradings.

Although largely unnecessary for detecting cirrhosis nowadays, biopsy is still often used to do so. Pathology is also useful in identifying hepatocellular carcinoma when there is not obvious tumour mass, and negative serum alpha-fetoprotein.

Liver tissue is essential to cell-based research studies, such as analysis of cytotoxic lymphocytes in a diseased organ. Various in situ staining techniques obviously need tissue sections to be useful. As a concluding note, Dr Scheuer referred to a study which had shown that progression of fibrosis is related to age of the patient at infection, duration of disease, high alcohol intake, and male sex – purely derived by a sophisticated scoring system of biopsy pathology.

Liver Biopsy:

Liver biopsy is not necessary for diagnosis, but it is helpful for grading the severity of disease and staging the degree of fibrosis and permanent architectural damage. Hematoxylin and eosin stains and Masson's trichrome stain are used to grade the amount of necrosis and inflammation and to stage the degree of fibrosis. Specific immunohistochemical stains for HCV have not been developed for routine use. Liver biopsy is also helpful in ruling out other causes of liver disease, such as alcoholic liver injury or iron overload.

HCV causes the following changes in liver tissue:

Necrosis and inflammation around the portal areas, so-called "piecemeal necrosis."

Necrosis of hepatocytes and focal inflammation in the liver parenchyma.

Inflammatory cells in the portal areas ("portal inflammation").

Fibrosis, with early stages being confined to the portal tracts, intermediate stages being expansion of the portal tracts and bridging between portal areas or to the central area, and late stages being frank cirrhosis characterized by architectural disruption of the liver with fibrosis and regeneration.

Grading and Staging of hepatitis by assigning scores for severity are helpful in managing patients with chronic hepatitis. The degree of inflammation and necrosis can be assessed as none, minimal, mild, moderate, or severe. The degree of fibrosis can be assessed similarly. Scoring systems are particularly helpful in clinical studies on chronic hepatitis.

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hello. I am new to this site. I am waiting for the results of my liver biopsy which I should know today or tomorrow. Could anyone tell me what questions I need to ask the doctor as far as results or about my liverpanel in general so that when I do research on my own I will know what I'm dealing with? For example: the number of my viral load; what genotype? what different technical stats or counts? In general, anything I need to know to do my own research as to wether or not I should do the standard treatment.Your help is appreciated. Dean