Daijiworld Media Network – New Delhi
New Delhi, Feb 8: Novel non-invasive liver disease assessments (NILDAs) can effectively replace liver biopsy for assessing liver fibrosis in patients with metabolic dysfunction-associated steatotic liver disease (MASLD), a 2026 systematic review has found.
The review highlighted that newer diagnostic tools show good to excellent accuracy in identifying advanced liver fibrosis and cirrhosis, offering a safer and less invasive option compared to traditional liver biopsy.
Currently used NILDAs include the Fibrosis-4 (FIB-4) index, Aspartate Platelet Ratio Index (APRI), and liver stiffness measurement (LSM) through transient elastography (TE) and magnetic resonance elastography (MRE). However, researchers noted that these tests often produce indeterminate results and their accuracy varies across different patient populations.
The review analysed over 900 studies published between 2020 and 2025. Of these, 48 met the inclusion criteria, while 15 additional novel tests—previously omitted from recent American Association for the Study of Liver Diseases (AASLD) guidelines—were also evaluated.
Several of the 15 novel NILDAs demonstrated strong diagnostic performance, supporting their use as alternatives to liver biopsy. The findings suggest that these tests could improve early detection and clinical decision-making in MASLD patients.
Current AASLD guidelines recommend combining blood-based and imaging-based NILDAs. Patients with a FIB-4 score of 1.3 or above are advised to undergo further imaging evaluation, usually through TE or MRE.
The review pointed to Agile 3+ and Agile 4 as promising tools that could replace LSM alone for diagnosing advanced fibrosis and cirrhosis, respectively. Developed for use in secondary and tertiary hepatology centres, these scores incorporate variables such as liver stiffness, platelet count, sex and diabetes status.
Researchers found that using FIB-4 followed by Agile 3+ or Agile 4 reduced indeterminate results while maintaining accuracy comparable to TE-based LSM.
The Agile scores performed similarly to conventional elastography but provided clearer classification when combined with FIB-4. However, concerns remain regarding the accessibility and cost-effectiveness of some novel NILDAs, particularly those relying on specialised biomarkers.
That said, many newer models use readily available clinical data such as age, BMI and diabetes status, raising the possibility of home-based or primary-care screening tools in the future.
According to the review, traditional tools like FIB-4 and TE remain useful for ruling out advanced fibrosis, while novel NILDAs may be more effective in identifying patients who already have significant liver damage.
The study also noted the potential role of artificial intelligence in developing more accurate NILDAs, though further research is required before widespread clinical adoption.