New Pain-Free Alternative to Biopsy: evaluation, treatment and follow-up options for Hepatitis C patients
ShearWave™ Elastography (SWE)
ShearWave is a form of ultrasound elastography that uses fast-moving shear waves to determine tissue stiffness, which is an important diagnostic tool for staging chronic liver disease. To achieve real-time quantification of tissue stiffness demands a high-speed acquisition of images. The SWE color-coded map provides the ability to visualize and analyze tissue stiffness during an examination.
Avoiding Invasive Procedures
According to an American Association for the Study of Liver Diseases position paper, in 2009 the three major roles of liver biopsy were: 1) diagnosis, (2) disease staging, and/or (3) assistance for making therapeutic management decisions. The authors noted, however, that non-invasive alternatives “may replace use of liver histology in [prognosis and treatment], particularly with regard to assessment of the severity of liver fibrosis.” The advances in Hepatitis C treatment since then make that prediction accurate.
Biopsies pose relatively small risks of morbidity and an extremely small risk of mortality, but their more common risks are still a burden for patients: between 25% and 30% experience pain, for instance, and the duration of the procedure plus a recovery period is several hours. Possible complications include bleeding that requires hospitalization or transfusion or the puncture of a surrounding organ. In addition to those burdens, a liver biopsy costs between $1,500 and $2,000 when there are no complications.
The risks of an invasive procedure might outweigh the benefits of a non-invasive alternative, of course, if the results were more accurate or better suited to the available treatment options. But in the case of liver fibrosis, a SWE scan can sometimes overcome biopsy’s sampling limitations. SWE can reduce the possibility of sampling error that arises from the very nature of a biopsy –that is, the selective sampling of a large organ. Using ultrasound-guided imaging technology to zero in on areas of interest in real time can thus prevent the need for follow-ups due to variability in sampling. This is not a small consideration, as eliminating a follow-up biopsy can decrease the patient’s time in the clinic, likely increasing their satisfaction, and improving clinical throughput.
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