Several histologic scoring systems have been developed to grade (inflammation) and stage (fibrosis) hepatic disease caused by hepatitis. Some scoring systems are complex, such as Knodell or Ishak, and because of their complexity are primarily only used in large cohort clinical trials. For general clinical purposes, most use the less complicated scoring systems that have only three to four categories, such as Batts and Ludwig, METAVIR, and International Association for Study of the Liver (IASL). The main determinants of inflammatory activity are lymphocytic piecemeal necrosis, lobular necroinflammation, and portal inflammation, which are graded 0 to 4 in most classification systems (Figure 1). The main determinants of fibrosis are the length in expansion of fibrotic areas between portal tracts and these changes are staged 0 to 4 in the classification systems commonly used in clinical practice (Figure 2).