Needle liver biopsy has been used as the "gold standard" for the assessment of liver fibrosis and disease stage of PBC . Due to possible complications of this procedure, for both, the physician and the patient, the decision to proceed with liver biopsy is not trivial one. So, scientists tend to introduce non-invasive methods for assessment of liver diseases stages.

A research article to be published on February 7, 2009 in the World Journal of Gastroenterology addresses this question. In the literature, The research team was led by Tamara Alempijevic found a statistical significant correlation between PBC stage and AST, APRI, ALT/platelet, AST/ALT, ALT/AST and ALT/Chol ratio. The best sensitivity and specificity was shown for AST/ALT, with the area under ROC of 0.660.

Based on these results, they concluded that use of biochemical markers and their ratios in clinical evaluation of PBC patients may reduce, but not eliminate the need for liver biopsy.