Beschreibung:
<jats:sec><jats:title>Aims</jats:title><jats:p>In this study, we aimed to evaluate the use of typical histological features of both the revised original (1999) and simplified (2008) criteria in the diagnosis of autoimmune hepatitis (<jats:styled-content style="fixed-case">AIH</jats:styled-content>) in clinical practice.</jats:p></jats:sec><jats:sec><jats:title>Methods and results</jats:title><jats:p>We performed a detailed histopathological evaluation of the pretreatment biopsies of 63 <jats:styled-content style="fixed-case">AIH</jats:styled-content> patients, and used biopsies of 62 untreated chronic viral hepatitis patients [hepatitis B (<jats:italic>n</jats:italic> = 21) or hepatitis C (<jats:italic>n</jats:italic> = 41)] as a reference cohort. Biopsies were systematically reviewed for inflammation, fibrosis and the presence of interface hepatitis, plasma cells, rosettes and emperipolesis with a well‐defined assessment method. <jats:styled-content style="fixed-case">AIH</jats:styled-content> biopsies showed more interface hepatitis (87% versus 63%, <jats:italic>P</jats:italic> = 0.002), more plasma cell‐rich infiltrates (48% versus 27%, <jats:italic>P</jats:italic> = 0.02), more rosettes (49% versus 23%, <jats:italic>P</jats:italic> = 0.004) and more emperipolesis (78% versus 50%, <jats:italic>P</jats:italic> = 0.001) than chronic viral hepatitis biopsies. Emperipolesis (<jats:italic>P</jats:italic> = 0.01) and rosettes (<jats:italic>P</jats:italic> < 0.01) were superior to plasma cells and interface hepatitis as independent predictors for <jats:styled-content style="fixed-case">AIH</jats:styled-content>. Moderate to severe lymphocytic cholangitis was found in 28% of <jats:styled-content style="fixed-case">AIH</jats:styled-content> patients.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Emperipolesis and rosette formation are superior histological predictors of <jats:styled-content style="fixed-case">AIH</jats:styled-content> than the classic hallmark features of interface hepatitis and plasma cells. In addition, moderate to severe lymphocytic cholangitis does not preclude the diagnosis of <jats:styled-content style="fixed-case">AIH</jats:styled-content>.</jats:p></jats:sec>