HCV METAVIR fibrosis staging:  My old Marine suffered mightily when he was subjected to a “blind” (not ultrasound or CT guided) liver biopsy given by a resident at a teaching hospital.  The resident had to make several passes to get a sample.

After 13 years of SVR status, the odds are good that he won’t need another liver puncture due to HCV. HCV residuals and HCV treatment (PEG-IFN-48 weeks) may require investigation in the future; because new technologies are being adapted, he need not suffer jabbing from another long fat biopsy needle.

The VA does not seem to promise veterans post-treatment cures or a lack of  liver disease progression even if a patient achieves SVR.  Patients are urged to take care of themselves, which is fine advice when they have the means and ability to do so.

The VA states (LINK to pdf): Achieving an SVR with HCV treatment improves clinical outcome. Liver fibrosis may improve (regress) after achieving an SVR. Patients with cirrhosis who achieve an SVR also have
reduced progression of their liver disease and reduced risk of HCC, liver failure, and death related to liver disease, as well as reduced all-cause mortality.

Image: The Royal College of Pathologists of Australasia

Liver biopsies, until recently, were considered the “gold standard,” but the VA and other medical establishments now appear to have downgraded their diagnostic usefulness.  Now they aren’t even a silver or bronze standard.

VA HCV treatment advisory dated 10/18/17. Title: Chronic Hepatitis C (HCV) Infection: Treatment Considerations screenshot from page 45. Click image to read whole document.

VA advises their providers, “Liver biopsies may be considered but it is invasive and limited by potential sampling error.”  I was pleased to see that the VA lists Magnetic Resonance elastography (MRE), invented by the Mayo Clinic (LINK), on their approved list.

Then and now

    from VA Liver Fibrosis webpage (LINK)

Liver biopsy has been the gold standard for the assessment of histologic changes in the liver. In the past, liver biopsy was routinely performed in patients with HCV, particularly before HCV treatment…

…Requirements: If a biopsy is necessary, it should only be performed when the information will be useful for optimal patient care and cannot be obtained in another way. Furthermore, biopsy should only be performed after written informed consent has been obtained.

Liver biopsy sampling errors versus Magnetic Resonance Elastography (MRE) briefly explained in this short Mayo Clinic video. Click to view on Youtube.

The good news is that if gut problems arise again, one need not avoid going to the doctor due to fear of a painful needle biopsy.

The VA may be in the process of purchasing this technology but there are non-VA providers in certain areas of the country;  DoD has one at Lackland AFB according to the map below.  (The VA has invested in other noninvasive technologies.)

Mayo technical article (full text): MR elastography of liver disease: State of the art

For locations (LINK) and information (LINK).

I like the fact that Mayo Clinic and other researchers are studying MRE applications in breast, brain, and other parts of human anatomy.  A safe, accurate MRE liver exam takes about 15 minutes.  Takeaway?  A state-of-the-art, painlessly derived visual map of the entire organ will result in better cheaper patient care.  Call David (if he’s staying put–which the WaPo reports may not be the case).

Kiedove