Dedicated to accelerating the acceptance and adoption of non-invasive diagnostics as an alternative to biopsy
Global Liver Institute launched the Beyond the Biopsy initiative in September 2020 to promote awareness and education about the use of non-invasive diagnostics as an alternative to biopsies. The initiative encourages advocates to support greater adoption of non-invasive diagnostics by directly influencing legislative, regulatory, and coverage/reimbursement changes.
The launch of the initiative included a national radio tour and virtual panels focusing on three states (Colorado, Massachusetts, and New York) with leading experts, policymakers, and patient advocates featured as speakers. Read about the launch of Beyond the Biopsy in our Summary Report of September 2020 [PDF] and learn more about the initiative below.
September 2020: GLI LIVE Beyond the Biopsy Panels Schedule
GLI LIVE: Beyond the Biopsy, The Colorado Panel Watch the episode on Facebook
GLI LIVE: Beyond the Biopsy, The Massachusetts Panel Watch the episode on Facebook
GLI LIVE: Beyond the Biopsy, The New York Panel Watch the episode on Facebook
GLI LIVE: Beyond the Biopsy, in Review Watch the episode on Facebook
Biopsy Basics
Liver biopsy has historically been associated with diagnosing liver disease and is still frequently used in clinical trials. Liver biopsy may be valuable but, increasingly in clinical practice, non-invasive diagnostics can be used. Liver biopsies are invasive, carry risk to patients, and subject to performance and interpretation inaccuracies.
In the majority of circumstances, non-invasive diagnostics (such as blood tests and imaging tests) can be used to avoid liver biopsy and provide more information than a biopsy through their ability to assess broader changes in the liver rather than only in the relatively small amount of liver tissue typically obtained from a liver biopsy.
Ask Your Doctor Before the Biopsy
What is the reason for doing the biopsy?
What are the noninvasive alternatives?
What are the processes for minimizing pain and discomfort?
How is the risk of bleeding minimized?
How soon will I get the results?
Complications of Biopsy
Complications are rare, but can occur. Complications of Biopsy include:
Bleeding
Pneumothorax
Hemothorax
Perforation of viscous organs
Inadvertent biopsy of the kidney
Bile peritonitis
Infection (bacteremia, abscess, sepsis)
Hemobilia
Death
Alternatives to Biopsy
In some circumstances, a liver biopsy is extremely valuable, helpful, and perhaps even necessary, but in other circumstances non-invasive diagnostics can be used to avoid liver biopsy. These non-invasive alternatives potentially provide more information than biopsy, through their ability to assess changes throughout the liver, rather than only in the relatively small amount of liver tissue typically obtained from a liver biopsy.
From blood tests to imaging, alternatives to biopsy exist. Healthcare providers should increase the number of diagnoses and decrease the number of liver biopsies using non-invasive diagnostics.
What non-invasive diagnostics are there?
Blood tests: Different tests on the blood to calculate the amount of fat in the liver. They can be imprecise and not reflect the true degree of liver fibrosis. Specific blood tests include AST to Platelet Ratio Index (APRI), Fibrosis-4 Test (FIB-4), Enhanced Liver Fibrosis (ELF), and FibroTest.
Multiparametric Magnetic Resonance Imaging (LiverMultiScan): Imaging technology that uses MRI to measure liver fat, iron, fibrosis and inflammation in a scan of up to 15 minutes.
Transient Elastography (Fibroscan): Imaging device that uses ultrasound to measure liver stiffness.
Magnetic Resonance Elastography (MRE): Imaging technology that combines MRI with sound waves to create a visual map (elastogram) to measure liver stiffness.
Shear Wave Elastography: Imaging technology that uses ultrasound to measure liver stiffness.
Ask your doctor which tests are appropriate in your case.
Going Beyond the Biopsy
Non-invasive alternatives are necessary to respond to the growing incidence of NAFLD, NASH, and other liver diseases. The symptoms of NASH are hard to recognize, as such, it remains under diagnosed. Newer non-invasive screening and diagnostic tools are now being used, offering a safer and more thorough examination of the liver.
Patient Voices
“The biopsy was very frightening. It’s degrading using bedpans, and horrendous lying motionless for hours afterwards. I have since had more biopsies, each one equally painful and traumatic - meaning time off from work for my husband or daughter.”
- Jenny, Liver transplant patient who has undergone multiple biopsies
“I only found out my diagnosis, NASH, from my discharge papers. I found out what NASH was by looking it up on Google. I definitely would have benefited from point-of-care patient counseling.”
- Kimberly, NASH and liver transplant patient
Share Your Story
Beyond the Biopsy Summary of September 2020 Report
The Global Liver Institute (GLI) Beyond the Biopsy Initiative was developed to promote awareness and education about the use of non-invasive diagnostics as an alternative to biopsies. The Initiative also directs advocacy support to encourage greater adoption of non-invasive diagnostics by directly influencing legislative, regulatory, and coverage/reimbursement changes.
