Buzzetti E, et al. - In patients with non-alcoholic fatty liver disease (NAFLD), the hepatic manifestation of the metabolic syndrome affecting 30% of the population in industrialised countries, researchers, for the first time, tested the ability of collagen proportionate area (CPA), a technique that quantifies fibrous tissue in liver biopsies by measuring the amount of collagen deposition as a proportion of the total biopsy area, to quantify fibrosis and predict clinical outcomes. A sub-group of patients evaluated the correlation between CPA and liver stiffness. In this study involving a cohort of 437 patients with longitudinal follow-up, CPA measures fibrosis accurately and is an independent clinical outcome predictor in NAFLD. CPA correlated throughout the whole spectrum of fibrosis with liver stiffness and liver fibrosis stage. It, therefore, merits further evaluation in clinical trials as a surrogate endpoint.