{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T14:04:10Z","timestamp":1785074650715,"version":"3.55.0"},"reference-count":85,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Sage Open Pathology"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background and significance<\/jats:title>\n                    <jats:p>Autoimmune biliary diseases, such as primary sclerosing cholangitis (PSC), Primary biliary cholangitis (PBC) and IgG4-related sclerosing cholangitis (IgG4-SC) are recognized as contributors to chronic cholestatic liver disease. Time-to-diagnosis remains prolonged, despite the presence of high resolution MRCP, expanded autoantibody panels and improved endoscopic tissue acquisition. This is due to the fragmented disease-specific pathways, variable marker sensitivity, overlap syndromes, malignant mimickers and in some cases early\/small-duct imaging limitations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Critically evaluate and synthesize current diagnostic modalities and propose an integrated, precision-layered, phenotype-defined, and tissue-informed diagnostic pathway that standardizes evaluation across autoimmune and immune-mediated cholangiopathies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Major society guidelines such as AASLD\/EASL, key reviews and pivotal studies were used in order to extract evidence regarding autoimmune serologies, MRCP and advanced MRCP techniques, elastography\/MRE for fibrosis staging and targeted endoscopic-tissue diagnostics, emphasizing on overlap phenotypes, intermediate strictures and malignancy exclusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Seronegative\/atypical PBC, limited sensitivity of MRCP in early or small-duct PSC, as well as frequent misclassification of IgG4-SC as PSC; are remarkable contributors of diagnostic delay. Iterative resolution, achieved through sequential escalation from serology to non-invasive ductal mapping, selective tissue clarification and investigational molecular and AI-assisted tools such as radiomics-enhanced MRCP, molecular cytology and liquid biopsy when conventional modalities fail, all aimed to improve discrimination of overlaps and support risk-stratified surveillance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Diagnostic uncertainty and disease misclassification may be reduced by implementing a precision-layered, phenotype-defined, and tissue-informed diagnostic pathway. This will standardize evaluation across autoimmune biliary diseases. 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