Dual cut-offs and beyond: Expanding the role of transient elastography in primary biliary cholangitis

Abstract

Accurate fibrosis staging is pivotal in the management of primary biliary cholangitis (PBC). Although liver biopsy is considered the diagnostic gold standard, its invasiveness limits widespread use in disease monitoring. Chen et al provided strong evidence validating vibration-controlled transient elastography (VCTE) as a noninvasive alternative for identifying advanced fibrosis in Chinese patients with PBC. By establishing dual cut-offs (≤ 10.0 kPa and > 14.5 kPa) with high diagnostic performance, the authors offer a clinically applicable tool that could substantially reduce the need for biopsy. Nevertheless, challenges persist, including the management of intermediate “grey zone” results, technical variability, and the confounding effects of cholestasis and inflammation. The integration of elastography with biochemical and prognostic indices, such as the GLOBE and UK-PBC scores, is essential for individualized care. This editorial discusses the expanding role of VCTE in PBC, current limitations, and future research directions toward standardized, integrated, noninvasive fibrosis assessment, and individualized PBC care.

Keywords: Primary biliary cholangitis; Vibration-controlled transient elastography; Liver stiffness measurement; Prognostic value; Liver fibrosis staging

Core Tip: Transient elastography is transforming the fibrosis evaluation in primary biliary cholangitis (PBC). The dual cut-offs proposed by Chen et al (≤ 10 kPa and > 14.5 kPa) achieved excellent diagnostic accuracy and could eliminate the need for biopsy in most patients. However, interpretation requires attention to confounders such as cholestasis, inflammation, and overlap syndromes. Standardized protocols, cross-modality validation, and integration with clinical scores will define the next frontier of precision staging for PBC.