Abstract
Autoimmune hepatitis (AIH) is a kind of chronic inflammatory liver disease mainly characterized by hepatocellular damage. There is no gold standard for its diagnosis, and it still relies on liver histological examination. Pathological examination is indispensable in the differential diagnosis and disease assessment of AIH. This article systematically reviews the evolution of pathological diagnostic criteria for AIH since the introduction of the initial scoring system by the International AIH in 1993, moving from early-stage empirical descriptions to quantitative scoring systems and then to the ongoing advancement of the latest international consensus standards. The standardization and accuracy of pathological diagnosis have significantly improved; at the same time, it reflects that the role of pathology in diagnosing AIH has shifted from a traditional auxiliary role to a key role in definitive diagnosis. The core pathological features of AIH include interface hepatitis, lymphoplasmacytic infiltrate, and hepatocellular rosettes; however, none of which are specific. The scarcity of specialized professionals, insufficient diagnostic resources at the foundation level, and the high subjectivity of pathological evaluation are the primary factors promoting to the current challenges in the pathological diagnosis of AIH. Quantitative pathological assessment, digital pathology, artificial intelligence assistance, and other advancements could drive the development of pathological diagnosis in AIH in the future.