Ask the author session with Dr. Yasaman Vali
A recent publication entitled “Precision in Liver Diagnosis: Varied accuracy across subgroups on the need for viable thresholds in diagnosis of MASLD” by Dr. Yasaman Vali and colleagues, explores the variability in diagnostic accuracy of non-invasive tests (NITs) for metabolic dysfunction-associated steatotic liver disease (MASLD) across different clinical subgroups. An “Ask the Author” session hosted by Professor Jean-François Dufour discusses the key findings of this paper with Dr. Vali. This article summarizes the main points of their conversation, inviting physicians and healthcare professionals to view the video for a more in-depth understanding.
The Context of the Study
The study addresses the variations in the recorded performance of non-invasive tests, raising concerns about their reliability and impact on accurate diagnoses of MASLD. It is known that NIT performance varies across settings and subgroups. The study systematically evaluated whether the performance of three NITs in detecting advanced fibrosis in patients with MASLD varies with age, sex, body mass index (BMI), type 2 diabetes mellitus (T2DM) status or liver enzymes.
Study Design and Population
The study is a diagnostic accuracy study that analyzed data from the LITMUS Metacohort, a large NAFLD registry. The researchers evaluated data from over 500 patients with biopsy-confirmed MASLD. The study aimed to assess how accurately three non-invasive tests—FIB-4, enhanced liver fibrosis (ELF), and vibration-controlled transient elastography liver stiffness measurement (VCTE LSM)—could detect advanced fibrosis (≥F3) across different patient subgroups. They examined characteristics such as BMI, sex, age, liver enzyme levels, and diabetic status to assess how these factors might affect test performance. Thresholds for detecting advanced fibrosis were calculated for each NIT for fixed (high) sensitivity, specificity and predictive values.
Key Findings
- The study found that the overall performance of the NITs in detecting advanced fibrosis was comparable across different clinical factors. Differences in AUC between all subgroups were small and statistically not significant.
- However, different thresholds were needed to achieve the same level of accuracy (sensitivity, specificity, and predictive values) in different subgroups.
- For example, higher thresholds were required for patients with diabetes to achieve the same level of accuracy compared to those without diabetes.
Impact and the Need for Personalized Diagnosis
The study highlights that fixed thresholds for NITs could be misleading in diagnosis, and tailoring them to individual patient characteristics can make a significant difference. By using a personalized approach, diagnostic tests can become more accurate. While the field of medicine is rapidly moving towards personalized treatment, personalized diagnosis has not received as much attention. This research can help shift this perspective.
Conclusion
By tailoring diagnostic thresholds to patients’ characteristics, diagnoses can be made in a more accurate and timely manner, ultimately helping clinicians provide better care for MASLD patients.
We invite physicians and healthcare professionals to watch the full “Ask the Author” session to gain a deeper understanding of this important research and its implications for clinical practice.
