Autoimmune hepatitis Diagnostic of choice

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2]


Liver biopsy is the gold standard test for the diagnosis of autoimmune hepatitis. Interface hepatitis (ie, piecemeal necrosis) is the histological hallmark of autoimmune hepatitis. In cirrhosis, fibrosis, bridging necrosis are usually found. Liver biospy is also used to diagnose overlap syndrome.

Diagnostic Study of Choice

Histology findings usually found on biopsy:

  • Interface hepatitis (ie, piecemeal necrosis) is the histological hallmark.
    • Portal lesion spares the biliary tree
    • This involves most of the lobule
    • Lobular collapse which is best identified by reticulin staining.
    • There is lymphoplasmacytic periportal infiltrate which invade the limiting plate.
    • There is an abundance of plasma cells and eosinophils are usually present.
  • A plasma cell infiltrate lead to plasma cell hepatitis, If it involves lobules called lobular or whole liver known as panacinar hepatitis.

In cirrhosis following findings are seen on biopsy:

Overlap syndrome

Liver biospy is also used to diagnose overlap syndrome:[5][6]

Histology findings of overlap syndrome
Types Biopsy findings
  • Ductopenia
  • Portal edema or fibrous
AIH-cholestatic syndrome


  1. Carpenter HA, Czaja AJ (2002). "The role of histologic evaluation in the diagnosis and management of autoimmune hepatitis and its variants". Clin Liver Dis. 6 (3): 685–705. PMID 12362575.
  2. Szabó Z (2006). "[The role of liver biopsy in the diagnosis of autoimmune hepatitis]". Orv Hetil (in Hungarian). 147 (35): 1697–702. PMID 17051746.
  3. Suzuki A, Brunt EM, Kleiner DE, Miquel R, Smyrk TC, Andrade RJ, Lucena MI, Castiella A, Lindor K, Björnsson E (2011). "The use of liver biopsy evaluation in discrimination of idiopathic autoimmune hepatitis versus drug-induced liver injury". Hepatology. 54 (3): 931–9. doi:10.1002/hep.24481. PMC 3192933. PMID 21674554.
  4. Tiniakos DG, Brain JG, Bury YA (2015). "Role of Histopathology in Autoimmune Hepatitis". Dig Dis. 33 Suppl 2: 53–64. doi:10.1159/000440747. PMID 26642062.
  5. Chapman R, Fevery J, Kalloo A, Nagorney DM, Boberg KM, Shneider B, Gores GJ (2010). "Diagnosis and management of primary sclerosing cholangitis". Hepatology. 51 (2): 660–78. doi:10.1002/hep.23294. PMID 20101749.
  6. Dienes HP, Erberich H, Dries V, Schirmacher P, Lohse A (2002). "Autoimmune hepatitis and overlap syndromes". Clin Liver Dis. 6 (2): 349–62, vi. PMID 12122860.