Liver biopsy is considered to be the most specific analysis to assess the nature and severity of liver disease. In case of chronic hepatitis, scoring liver biopsies is an established part of the pathologist's work. Four different scores are most often used: the Scheuer, Ludwig and French METAVIR systems, which are fairly simple, and the Ischak score, which is more complex. All systems generate scores, which are based upon inflammatory activity (the grade) and fibrosis (the stage), with splitting of these two components. To be valid in routine analyses, a scoring system must be clinically relevant, reproducible and simple to understand and to apply. Scoring will then be helpful to study series of patients and to evaluate the efficacy of new therapeutic strategies. However, a score does not replace the study of a liver biopsy and the generated numbers does not correspond to true measurements. Furthermore, its accuracy will always depend on adequate sampling.