A liver biopsy can be an effective tool for assessing the damage that hepatitis C (HCV) may have caused to the liver. Biopsies are used determine the stage of liver disease and to help guide decisions in antiviral treatment. However, with the arrival of newer treatments and blood tests the need for biopsies might not be as necessary as they traditionally once were. We asked our expert Sue to share her thoughts.
I believe that the need for biopsy for many patients may not be necessary. Now that the treatments are so successful, it is not as important to know the stage and grade of the virus. Most successfully treated patients will improve the histology of their liver in the months and years following a sustained viral response. Biopsies have not changed the treatment decisions for the majority of patients, since the DAA’s have been approved. It is an unnecessary expense, it may be painful, it is anxiety producing and it is quite invasive, putting a patient at a slight risk of bleeding and other serious complications. There is also a 30% chance of a sampling error.
If the physician is not sure whether the patient has cirrhosis, and if management of the treatment, such as duration and whether ribavirin should be added, would depend on stage of the disease, then biopsy would be indicated. In many cases, however, a physician will get an idea if the patient has late stage disease through his/her physical exam and blood work. There are also bio-chemical markers of fibrosis that help a physician stage the disease. Fibrosure, Fibroscan, Fibrospect, and APRI scoring are effective ways to stage hepatitis C infection.
I believe that whether a patient should undergo biopsy is an individual decision that a doctor should make after careful examination of the medical history of each patient.