The evolving landscape of pathologic interpretation in metabolic dysfunction-associated steatotic liver disease

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disease worldwide. This article discussed updates in diagnosis and emerging issues. Key histologic findings include steatosis, lobular inflammation, and hepatocyte ballooning. Updated histologic guidance, with more detailed definitions, has recently been published for features in the histologic spectrum. Studies in portal changes seen in MASLD have shown the importance of this finding in relation to fibrosis and outcome. Among the emerging issues, the importance of incidental findings and regression of fibrosis features is described. Digital pathology/machine learning algorithms, stain-free technologies, and molecular testing are being integrated into the diagnosis of MASLD, still mostly in the research setting but rapidly capturing the attention of the clinical community with the intent of aiding pathologists.