Diagnosis of the stage of liver fibrosis is essential for making a prognosis and deciding an antiviral therapy. Liver biopsy is the gold standard for fibrosis staging, but due to its limitations, alternative tests for liver fibrosis evaluation have been developed. Among them, serum markers and transient elastography have been compared against histology. Aim of work: Evaluate the efficacy of transient elastography in the diagnosis of hepatic fibrosis among Egyptian chronic HCV patients.Patients and methods: Our study included 197 chronic HCV patients and for them routine investigations, ultrasound guided liver biopsy and liver stiffness measurement using fibroscan were done. All biopsy specimens were analyzed by two experienced pathologists blinded to the results of each other and were classified according to the specimen length into ideal biopsy, subideal biopsy and not accepted. Results: 1- inter-observer variability between pathologists is less evident in fibrosis staging and is not related to the liver biopsy specimen length. 2- Fibroscan is a sensitive tool in detection of significant fibrosis F≥2 as assessed by the METAVIR score at a cut off level of 6.35 kpa and in detection of cirrhosis F≥4 at a cut off level of 10.75 kpa. 3- Schistososmal infection decrease the sensitivity of the new fibroscan score cut off level to detect significant fibrosis (F2-F3) as assessed by the METAVIR scoring system.