Hepatology is still a relatively young discipline in medicine. The birth of hepatology in the 1950s was largely dependent on the introduction of liver biopsy performed with the Menghini’s needle1 and its modifications. Ever since, diagnosis and staging of chronic liver diseases (CLDs) has been based on the morphological evaluation of liver tissue associated with grading and staging according to established scoring systems.2 3 The introduction of ultrasound scanning, practically the first easily available imaging tool, at the end of the 1970s, provided further diagnostic advantages for the hepatologist, and made liver biopsy a safer procedure. Nowadays, liver biopsy remains an essential tool for the diagnosis of the majority of liver diseases, while its clinical relevance is more limited to the staging of the disease in settings where the diagnosis is based on other established parameters, ie, viral markers in chronic viral hepatitis. Even though the prevalence of biopsy-related complications is very limited in tertiary centres, this procedure still carries a burden of potentially severe events.4 Moreover, sampling error and intra- and inter-observer variability represent major drawbacks.5 6 Overall, liver biopsy should be considered the “best possible reference standard” and does not allow discrimination of adjacent stages of fibrosis (ie, F2 vs F1 or F3 vs F2)6 7 with adequate diagnostic accuracy. Along this trend, hepatologists have started to develop non-invasive systems able to provide a surrogate estimate of disease staging, ie, semi-quantitative assessment of fibrosis. Overall, these attempts are aimed at fulfilling the dream of developing an accurate, easy and cost/effective non-invasive test that allows (1) fast screening, (2) longitudinal follow-up, (3) efficacy of therapeutic treatments; and (4) prognostic evaluation. This assumes a particular relevance in the paediatric setting, where the use of liver biopsy is perceived as bearing higher risks and is less …