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.

我们好奇地细读了 McPherson 等人最近的文章，该文章评估了无创纤维化测试 （NIT） 对代谢功能障碍相关脂肪性肝病 （MASLD） 患者肝纤维化分期的疗效。¹ 该研究专注于临床医生纤维化评估和组织学之间的一致性，这一点特别值得一提，因为它解决了肝病学临床实践的一个重要方面。

该研究提供了令人信服的证据，表明用于纤维化分期的算法方法，尤其是结构化 NIT 的顺序应用，可能比经验丰富的肝病学家所做的结构化程度较低的评估提供更高的准确性。这一发现强调了在 MASLD 背景下增强临床决策和患者管理的潜力。

然而，我们认为还有其他的思考值得进一步探索。首先，组织学确实是 NIT 值得信赖的参考标准，但不同的病理学家、不同的检测方法和不同的仪器也可能影响组织学结果，从而影响研究结果。其次，本文提到了 NIT 的一些局限性，例如 FIB-4 在老年人中的假阳性率较高，可以更深入地探讨并提出可能的解决方案或替代方案。

此外，不应忽视新兴诊断技术对研究中呈现的结果的潜在影响。C-X-C 基序趋化因子受体 4 和胞质分裂专用物 8 已被确定为 MASLD 进展的潜在诊断生物标志物。² 随着肝病学领域的不断发展，评估新工具如何补充或挑战当前实践至关重要。

总之，McPherson 等人的工作为我们理解肝纤维化评估中的 NIT 做出了宝贵的贡献。我们预计从这项研究中获得的见解将为未来的研究和临床指南提供信息，最终加强对 MASLD 患者的护理。