We read with great interest the study by Mózes et al on non-invasive tests (NITs) in non-alcoholic fatty liver disease (NAFLD)1 and commend the authors on their comprehensive individual patient data meta-analysis. The authors have confirmed that a two-step algorithm of fibrosis-4 index (FIB-4) and liver stiffness measurement with vibration controlled transient elastography (LSM-VCTE) has superior diagnostic performance for ruling in and ruling out advanced fibrosis and/or cirrhosis. Indeed, this concept has been demonstrated previously, including in our own work.2–4 However, we would like to highlight a few points for clarification. First, the authors suggest a reduction in liver biopsies from 33% to as low as 19% when using the proposed rule-in cut-offs for cirrhosis, as summarised in Sankey diagrams. In our opinion, this comparative reduction in biopsies is not justified as the first diagnostic algorithm …

中文翻译：

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NAFLD 中的无创检查和晚期慢性肝病：前进两步，后退一步？

我们非常感兴趣地阅读了 Mózes 等人关于非酒精性脂肪性肝病 (NAFLD) 的非侵入性测试 (NITs) 的研究1，并赞扬作者对他们全面的个体患者数据荟萃分析。作者已经证实，纤维化 4 指数 (FIB-4) 和使用振动控制瞬态弹性成像 (LSM-VCTE) 测量肝脏硬度的两步算法在诊断和排除晚期纤维化和/或肝硬化方面具有卓越的诊断性能. 事实上，这个概念之前已经证明过，包括在我们自己的工作中。2-4 但是，我们想强调几点需要澄清。首先，作者建议当使用建议的肝硬化规则截止值时，肝活检从 33% 减少到低至 19%，如 Sankey 图表中总结的那样。在我们看来，