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She Had a Disastrous Liver Biopsy
from Sharon S.

[After having read Ed’s Liver Biopsy article:]  Interesting!  I, too had a liver biopsy in 1983 to check my liver prior to methotrexate use.  The doctor ruptured my gall bladder and perforated my pancreas.  I was one sick puppy for a while.  No more blind biopsies for me!  -Sharon S.

*****

Ed’s Response:  Cripes!  I don’t blame you, Sharon!  The outcome of your liver biopsy shocks and stuns.  I’m wondering:  You wrote, “No more blind biopsies for me!”  Does that mean you did NOT undergo an ultrasound or a CT Scan prior to the procedure?  I don’t know if these were common practice in ’83, or not. 

The liver is a large organ with a weird shape that more-or-less “surrounds” other organs, including gall bladder and pancreas.  It sounds to me like your doctor “dug too deep,” passing right through the liver and into these other organs — something that either ultrasound or CT scanning is supposed to make unlikely because the radiologist (or other doctor) can “see” where the liver stops and other organs start. 

Well, no matter the reasons why, I completely understand your decision not to go through that again.  If it becomes necessary to have another liver biopsy you are completely within your rights to understand completely how they will conduct it, to make sure it’s not a “fishing expedition,” but a true “guided tour.”

Readers:  Liver biopsies prior to starting methotrexate therapy are usually done if blood work suggests some liver irregularities.  If initial blood work comes back “normal,” usually MTX therapy is started without requiring the biopsy.  In these cases a liver biopsy is typically prescribed when the patient’s accumulated doses of methotrexate equals 1 to 1.5 grams.  Depending on the patient’s individual prescription, this can be as soon as one year or not until two years or longer on the drug.  In Europe, another kind of blood test has been deemed “telling enough” to dispense with liver biopsies altogether.  This practice has not yet gained approval by doctors in the U.S.  The important thing to note is that human livers are resilient organs.  Damage like that which can be attributed to methotrexate toxicity is easily reversible if caught early and medication is stopped.  The reason doctors prescribe liver biopsies is the typical blood work (in the U.S., at least) used to detect liver malfunction is not as accurate as tissue analysis.  -Ed

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