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Clin Mol Hepatol. 2024;30(1):37-48.

Comparison of four histological scoring systems for autoimmune hepatitis to improve diagnostic sensitivity.

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제1저자 안수민 · 교신저자 정숙향, 김혜령

PMID 37953068 PMC10776291 DOI 10.3350/cmh.2023.0325 IF 21.7 소화기내과
소속 (6)
  1. Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
  2. Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  3. Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
  4. Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
  5. Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
  6. Department of Pathology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.

Abstract

BACKGROUND/AIMS The histological criteria in the 1999 and 2008 scoring systems proposed by the International Autoimmune Hepatitis Group (IAIHG) have their inherent limitations in diagnosing autoimmune hepatitis (AIH). In this study, we evaluated the histology components of four scoring systems (1. revised original scoring system ["1999 IAIHG"], 2. simplified scoring system ["2008 IAIHG"], 3. modified histologic criteria ["2017 UCSF"], and 4. a new histologic criteria proposed by the International AIH Pathology Group ["2022 IAHPG"]) in AIH patients.

METHODS Medical records and liver biopsies were retrospectively reviewed for 68 patients from two independent medical institutions, diagnosed with AIH based on the 1999 IAIHG system between 2006 and 2016. The histological features were reviewed in detail, and the four histological scoring systems were compared.

RESULTS Out of the 68 patients, 56 (82.4%) patients met the "probable" or "definite" AIH criteria of the 2008 IAIHG system, and the proportion of histologic score 2 (maximum) was 40/68 (58.8%). By applying the 2017 UCSF criteria, the number of histology score 2 increased to 60/68 (88.2%), and "probable" or "definite" AIH cases increased to 61/68 (89.7%). Finally, applying the 2022 IAHPG histology score resulted in the highest number of cases with histologic score 2 (64/68; 94.1%) and with a diagnosis of "probable" or "definite" AIH (62/68; 91.2%).

CONCLUSION The recently proposed UCSF/IAHPG histological criteria increased the histology score of AIH. Substituting the histology component of the 2008 IAIHG system with the 2022 IAHPG criteria increased the sensitivity for diagnosing AIH (≥"Probable AIH") from 82.4% to 91.2%.

Keywords

Autoimmune hepatitisDiagnosisHistology

Figures

Figure 1.
Figure 1. Representative histologic images of autoimmune hepatitis. (A) Interface hepatitis with dense lymphoplasmacytic infiltration. (B) Emperipolesis (arrow) is defined as the presence of lymphocytes or plasma cells within the cytoplasm of hepatocytes. (C) Hepatocyte rosettes (arrows) are defined as hepatocytes arranged around a clearly identifiable luminal space. All images are from hematoxylin and eosin stained slides at 200x magnification.
Figure 2.
Figure 2. Validation of autoimmune hepatitis scoring systems. (A) Percentage of maximum histology score for total patients (n=68). By 1999 IAIHG criteria, 73.5% of cases were given the maximum histologic score (*maximum score: 5). The proportion of cases with the maximum histological scores were lowest by the 2008 IAIHG system (58.8%), and highest by the 2022 IAHPG method (94.1%). (B) Total score of four scoring systems for total patients (n=68). All patients met ≥“Probable AIH” criteria by the 1999 IAIHG system. In contrast, 82.4% of patients met ≥“Probable AIH” of the 2008 IAIHG system. However, substituting UCSF and IAHPG histologic criteria to the 2008 IAIHG system resulted in increased sensitivity for diagnosing AIH (≥“Probable AIH”) from 82.4% to 89.7% and 91.2%, respectively. (C) Percentage of maximum histology score for patients with acute presentation or aggravation, n=32). By the 1999 IAIHG criteria, 81.3% of cases were given the maximum histologic score (*maximum score: 5). The proportion of cases with the maximum histological scores were lowest by the 2008 IAIHG system (65.6%), and highest by applying the 2022 IAHPG method (96.9%). (D) Total score of four scoring systems for patients with acute presentation or aggravation, n=32). All patients met ≥“Probable AIH” criteria by the 1999 IAIHG system. In contrast, 81.3% of patients met ≥“Probable AIH” of the 2008 IAIHG system. However, substituting UCSF and IAHPG histologic criteria to the 2008 IAIHG system resulted in increased sensitivity for diagnosing AIH (≥“Probable AIH”) from 81.3% to 90.6% and 93.8%, respectively. IAIHG, international autoimmune hepatitis group; IAHPG, international autoimmune hepatitis pathology group; AIH, autoimmune hepatitis.

그림 출처: PubMed Central 공개 논문 (PMC10776291)

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Conflict of interest statement

Conflicts of Interest . The authors have no conflictsto disclose.

그 밖의 정보
출판 형태
Journal Article
저널
Clinical and molecular hepatology · eISSN 2287-285X
전자 출판
2023-11-13
MeSH
Humans · Hepatitis, Autoimmune* / diagnosis / pathology · Retrospective Studies
연구비
Seoul National University Bundang Hospital SNUBH 02-2018-011 · The Korean Association for the Study of the Liver · The Korean Liver Foundation
참고문헌
26편