Non-Invasive Fibrosis Testing in Adults With Obesity and MASLD: A Systematic Review and Meta-Analysis.

In 30 seconds

This systematic review and meta-analysis assessed biopsy-referenced non-invasive tests for significant (≥F2) and advanced (≥F3) fibrosis in adults with obesity and MASLD. Across 27 studies including 5034 participants, vibration-controlled transient elastography (VCTE) had the most consistent performance, particularly for advanced fibrosis: sensitivity was 0.77 (95% CI, 0.67-0.85) and specificity was 0.84 (95% CI, 0.76-0.90). For significant fibrosis, VCTE and FIB-4 had broadly comparable accuracy. Serum-based tests showed more variable operating characteristics, and VCTE performance depended on threshold selection and technical feasibility.

Key findings

• For advanced fibrosis (≥F3), VCTE sensitivity was 0.77 (95% CI, 0.67-0.85) and specificity was 0.84 (95% CI, 0.76-0.90).
• For significant fibrosis (≥F2), VCTE sensitivity was 0.64 (95% CI, 0.49-0.77) and specificity was 0.77 (95% CI, 0.66-0.85).
• For significant fibrosis, FIB-4 showed broadly comparable performance: sensitivity 0.65 (95% CI, 0.53-0.75) and specificity 0.77 (95% CI, 0.64-0.86).
• Serum-based tests had more variable operating characteristics; lower VCTE cut-offs traded specificity for sensitivity.

Why it matters

Fibrosis assessment in adults with obesity and MASLD is clinically important, but test performance may not transfer uniformly across populations or thresholds. These pooled results suggest VCTE is a comparatively consistent option, especially for advanced fibrosis, while also showing that its accuracy is imperfect. Recognising threshold and feasibility effects can help interpret non-invasive results and underscores the need for obesity-specific validation.

What to keep in mind

The review included studies with differing test thresholds and operating characteristics; the abstract also identifies technical feasibility and the lack of validated obesity-specific thresholds as concerns.