MAST versus FAST for active fibrotic MASH: a meta-analysis supporting risk-stratified diagnostic pathways

Area of Science:

• Hepatology
• Diagnostic Accuracy
• Medical Imaging

Background:

• Metabolic dysfunction-associated steatohepatitis (MASH) with significant fibrosis is a growing health concern.
• Accurate non-invasive diagnostic tools are crucial for managing MASH.
• Existing diagnostic methods have limitations in identifying MASH with significant fibrosis.

Purpose of the Study:

• To compare the diagnostic accuracy of two novel non-invasive scores: FibroScan-AST (FAST) and MRI-AST (MAST).
• To evaluate the performance of FAST and MAST in identifying MASH with significant fibrosis.
• To assess the sensitivity, specificity, and overall accuracy of these scores against liver biopsy.

Main Methods:

• A systematic review and meta-analysis were conducted following PRISMA guidelines.
• Four studies comparing FAST and MAST against liver biopsy were included.
• Bivariate random-effects models were used to calculate pooled sensitivity, specificity, diagnostic odds ratio (DOR), and area under the curve (AUC).

Main Results:

• MAST showed higher sensitivity (55.9%) and specificity (88.1%) with an AUC of 0.84 compared to FAST (sensitivity 44.7%, specificity 87.5%, AUC 0.83).
• The difference in AUC between MAST and FAST was not statistically significant (p=0.964).
• MAST exhibited greater consistency, while FAST showed significant threshold variability.

Conclusions:

• MAST and FAST demonstrate comparable overall diagnostic accuracy for MASH with significant fibrosis.
• MAST may offer advantages in sensitivity and consistency.
• The limited number of included studies necessitates cautious interpretation of findings.