AIM: To our knowledge, the inter-observer variability of the liver biopsy findings in HBV-infected children have not been studied as yet. Hence, we aimed to compare different pathologist’s assessment of grading and staging in liver biopsies obtained from children prior to interferon treatment. METHODS: We collected 920 biopsies from 11 medical centers. The biopsies were independently reviewed by 6 pathologists from academic centers who assessed Batts-Ludwig score for grading and staging. Satisfactory agreement among observers was defined as at least 60% of observers having the same opinion. Satisfactory dispersion between maximal and minimal score for the same biopsy specimen was defined as a maximum 1 point. RESULTS: Satisfactory inter-observer agreement for grading was obtained in 51.6% and for staging in 75.7% of biopsies. Satisfactory dispersion for grading scores was observed in 44.5% and for staging in 72.7% of cases. CONCLUSION: Our study demonstrates that: (1) pathologists differ in their assessment of grading and staging of liver biopsies; (2) inter-observer variability for staging is lower than that for grading; and (3) regardless of the inter-observer variability of assessments, the majority of children with chronic HBV infection have mild to moderate inflammation and mild to moderate fibrosis. AIM: To our knowledge, the inter-observer variability of the liver biopsy findings in HBV-infected children have not been studied as yet. Therefore, we aimed to compare different pathologist’s assessment of grading and staging in liver biopsies obtained from children prior to interferon METHODS: We collected 920 biopsies from 11 medical centers. The biopsies were conducted reviewed by 6 pathologists from an academic center who assessed Batts-Ludwig score for grading and staging. Satisfactory agreement among observers was defined as at least 60% of observers having the Same opinion. Satisfactory dispersion between maximal and minimal score for the same biopsy specimen was defined as a maximum of 1 point. RESULTS: Satisfactory dispersion-maximal and minimal score for the same biopsy specimen was defined as a maximum of 1 point. scores was observed in 44.5% and for staging in 72.7% of cases. CONCLUSION: Our study demonstrates that: (1) pathologists diff er in their assessment of grading and staging of liver biopsies; (2) inter-observer variability for staging is lower than that for grading; and (3) regardless of the inter-observer variability of assessments, the majority of children with chronic HBV infection have mild to moderate inflammation and mild to moderate fibrosis