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Risk of liver biopsy as routine test
Nov 9, 2008

Dr McGovern,

I have a question regarding liver biopsy. My understanding is that liver biopsy is by far the most accurate tool to determine whether an HCV or HBV chronic infection is progressive. Unfortunately, some patients do lose their lives to this risky procedure.

I am wondering what is the chance that blood tests and radiology fail to reveal progressive disease (which will eventually lead to cirrhosis and cancer). How does this risk compare to the chance to dying from biopsy?

I am assuming that doctors don't recommend liver biopsy lightly because liver biopsy is more dangerous than HBV or HCV themselves, given normal blood tests and medical imaging results?

Thanks

Response from Dr. McGovern

Liver biopsy can be associated with a complication, but the risk is extremely low. The risk of dying is estimated about a tenth of one per cent...

Yes it is extremely helpful to have a biopsy to guide management since you can see not just scarring but also inflammation and the degree of fatty infiltration and other unsuspected diseases as well.

If you are extremely anxious, you can discuss a blood test marker for fibrosis only. These markers perform well in the extremes of disease - very advanced and very mild fibrosis. They do not perform as well in the "in between" spectrum.

Radiology is only helpful if the patient already has cirrhosis and varices - a complication of advanced disease. It can also tell if you have liver fat - but not if you have "steatohepatitis" which is much more concerning than "bland" fat.

Hope this is helpful.



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