Noninvasive liver fibrosis assessment in metabolic dysfunction-associated steatotic liver disease

Metabolic-dysfunction-associated steatotic liver disease (MASLD) is a leading cause of chronic liver disease worldwide, with global prevalence estimated at about 32%. The main predictor of clinical outcome is liver fibrosis severity, making an accurate diagnosis essential. This study evaluated the role and accuracy of noninvasive methods (NIMs) for assessing liver fibrosis in MASLD. A systematic literature search was conducted in the PubMed, Cochrane, SciELO, and LILACS databases using the keywords "metabolic steatotic liver disease", "noninvasive markers", "liver fibrosis", and related terms. A total of 76 articles were selected for review. NIMs offer advantages over liver biopsy due to their simplicity, accessibility, and reproducibility, enabling effective risk stratification at lower costs. Despite some limitations in defining intermediate fibrosis stages, a stepwise approach enhances diagnostic accuracy. Although liver biopsy remains the gold standard, NIMs are increasingly recognized for reliably excluding advanced fibrosis in patients with MASLD, reducing the need for invasive procedures.