The aim of this review was to emphasize the benefit of a methodical approach to ‘medical’ liver biopsy reporting and to illustrate that recognition of patterns of disease can greatly aid correct interpretation of these often-complex specimens. This applies both to assessment of the liver architecture and to evaluation of the likely disease aetiology. Therefore, a great deal of information can be obtained by examining biopsy material at low- and medium-power magnification, prior to confirming detailed features with high-power examination. A range of recommended special histochemical stains that personal experience has shown to be valuable is included. Emphasis is also placed on the absolutely key requirement for appropriate knowledge of the clinical situation within which the biopsy specimen was taken.