Modernizing metabolic dysfunction-associated steatotic liver disease diagnostics: the progressive shift from liver biopsy to noninvasive techniques.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a growing public health concern worldwide. Liver biopsy is the gold standard for diagnosing and staging MASLD, but it is invasive and carries associated risks. In recent years, there has been significant progress in developing noninvasive techniques for evaluation. This review article discusses briefly current available noninvasive assessments and the various liver biopsy techniques available for MASLD, including invasive techniques such as transjugular and transcutaneous needle biopsy, intraoperative/laparoscopic biopsy, and the evolving role of endoscopic ultrasound-guided biopsy. In addition to discussing the various biopsy techniques, we review the current state of knowledge on the histopathologic evaluation of MASLD, including the various scoring systems used to grade and stage the disease. We also explore current and alternative modalities for histopathologic evaluation, such as whole slide imaging and the utility of immunohistochemistry. Overall, this review article provides a comprehensive overview of the progress in liver biopsy techniques for MASLD and compares invasive and noninvasive modalities. However, beyond clinical trials, the practical application of liver biopsy may be limited, as ongoing advancements in noninvasive fibrosis assessments are expected to more effectively identify candidates for MASLD treatment in real-world settings. Plain language summary: Modernizing metabolic dysfunction-associated steatotic liver disease diagnostics: the progressive shift from liver biopsy to non-invasive techniques Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is a condition where fat builds up in the liver, causing inflammation and scarring. This problem is becoming more common worldwide and can lead to serious health issues like chronic liver disease, liver failure, and liver cancer. Doctors can use a method called a liver biopsy to check if a patient has a liver problem like MASLD. However, this method can be a bit risky because it involves inserting a needle into the liver to get a sample. Although doctors can also rely on blood work and different medical imaging approaches to assess the severity of liver disease, specifically MASLD, these options aren't completely accurate. Therefore, there is still a need for a liver biopsy. This article explores various methods and techniques that doctors can use to perform a liver biopsy. It explains how the sample taken with the needle can be analyzed under a microscope to help guide the management of patients with MASLD. We hope this review will be useful for doctors and researchers in the field of gastroenterology and hepatology. [ABSTRACT FROM AUTHOR]