October 29, 2026 · Lancet (London, England) · DOI: 10.1016/S0140-6736(26)01145-1

Non-invasive tests in metabolic dysfunction-associated steatotic liver disease: the LITMUS prospective multicentre diagnostic accuracy study.

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The LITMUS study asked whether non-invasive biomarkers and multimarker panels can accurately identify MASH, at-risk MASH, advanced fibrosis, and cirrhosis in MASLD patients, using biopsy as the reference standard. Across 1,590 biopsy-confirmed participants in Europe and the USA, no single marker reached the diagnostic threshold (AUC >0.80) for MASH alone, but the SomaSignal proteomic panel performed strongly for at-risk MASH (AUC 0.83) and advanced fibrosis (AUC 0.92), and FibroMeter-VCTE led for cirrhosis (AUC 0.94). Sequential two-step strategies starting with gamma-glutamyl transferase met the criterion for advanced fibrosis and at-risk MASH, suggesting multimarker and tiered testing may be able to partly replace biopsy.

Yasaman Vali, Kristy Wonders, Jenny Lee, Guruprasad P Aithal, Rocio Aller, Michael E D Allison, Johanna Arola, Jesus M Banales, Vanesa Bernal-Monterde, Annalisa Berzigotti, Jérôme Boursier, Clifford A Brass, Elisabetta Bugianesi, Jose Luis Calleja, Jeremy F Cobbold, Helena Cortez-Pinto, Javier Crespo, Susan Davies, Ann Driessen, Kevin L Duffin, Mattias Ekstedt, Daniel Forton, Céline Fournier-Poizat, Sven Francque, Andreas Geier, Joseph Gogain, Annette S H Gouw, Hannes Hagström, Adriaan G Holleboom, Prodromos Hytiroglou, Morten Karsdal, Carolin Lackner, Diana J Leeming, Luca Miele, George Papatheodoridis, Valerie Paradis, Michael Pavlides, Juan M Pericàs, Salvatore Petta, Vlad Ratziu, Manuel Romero-Gomez, Jörn M Schattenberg, Detlef Schuppan, Rambabu Surabattula, Ana Paula Silva, Mette Skalshøi Kjær, Beate K Straub, Gianluca Svegliati-Baroni, Dina Tiniakos, Maria Manuela Tonini, Richard Torstenson, Luca V C Valenti, Joanne Verheij, Jeremy Magnanensi, Rebeca Mayo, David Wenn, Hannele Yki-Järvinen, Carla Yunis, Patrick M Bossuyt, Quentin M Anstee

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Nov 4, 2026 · The New England journal of medicine

Dr. Jennifer Thompson

Portland, OR

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Non-invasive tests in metabolic dysfunction-associated steatotic liver disease: the LITMUS prospective multicentre diagnostic accuracy study.

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