Liver Biopsy in Primary Biliary Cholangitis: Indications and Interpretation.

Primary biliary cholangitis is a disease characterized by immune-mediated bile duct destruction, followed by inflammation, scarring, and the development of chronic cholestasis and a slow progression to cirrhosis over the course of years. Liver biopsy has traditionally been used in conjunction with clinical evaluation and serologic autoantibody testing to establish the diagnosis, but it is no longer required in typical cases with positive antimitochondrial antibodies. Biopsy remains essential, however, in antimitochondrial antibody-negative patients or suspected overlap syndrome with autoimmune hepatitis, and if an adequate biopsy is performed precise staging is possible for assessment of prognosis.