Letter: Using non-invasive fibrosis tests and emerging diagnostics to enhance the accuracy of liver fibrosis staging in MASLD patients

Abstract

We have perused with intrigue the recent article by McPherson et al., which appraises the efficacy of non-invasive fibrosis tests (NITs) for staging liver fibrosis in patients with metabolic dysfunction-associated steatotic liver disease (MASLD).¹ The study's concentration on the congruence between clinician fibrosis assessment and histology is particularly meritorious, as it addresses a significant facet of clinical practice in hepatology.

The research furnishes compelling evidence that algorithmic approaches to staging fibrosis, especially the sequential application of structured NITs, might offer greater precision than the less structured evaluations made by experienced hepatologists. This finding emphasizes the potential for enhanced clinical decision-making and patient management in the context of MASLD.

However, we opine that there are additional contemplations that warrant further exploration. First and foremost, histology is indeed a trustworthy reference standard for NITs, but dissimilar pathologists, diverse detection methods and distinct instruments may also influence the histological outcomes, and thereby impact the results of the study. Second, the paper alludes to some limitations of NITs, such as the higher false-positive rate of FIB-4 in the elderly, which can be probed in greater depth and possible solutions or alternatives proposed.

Furthermore, the potential influence of emerging diagnostic technologies on the findings presented in the study should not be disregarded. C-X-C motif chemokine receptor 4 and dedicator of cytokinesis 8 have been identified as potential diagnostic biomarkers for MASLD progression.² As the domain of hepatology keeps evolving, it is pivotal to assess how new tools may complement or challenge current practices.

In conclusion, the work by McPherson et al. provides a valuable contribution to our comprehension of NITs in the assessment of liver fibrosis. We anticipate that the insights gained from this study will inform future research and clinical guidelines, ultimately enhancing the care of patients with MASLD.

Wenjun Meng: Conceptualization; writing – original draft. Ping Yao: Conceptualization; writing – original draft. Yuan Dan: Conceptualization; writing – original draft.

None.

The authors have no conflict of interest to disclose.

This article is linked to McPherson et al paper. To view this article, visit https://doi.org/10.1111/apt.18061.