Non-invasive tests used to stage liver fibrosis in metabolic dysfunction-associated steatohepatitis play a growing role in care and trial recruitment, but their performance in routine practice may differ from results seen in clinical studies.
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Trials are clean. Clinics are not. Show me the real-world numbers first.
Of course the tests look great in trials. Trials pick clean patients, tidy biopsies and specialists who know exactly what they’re doing. Then the same blood panels and elastography machines get shoved into a overworked primary care clinic in Ohio, and suddenly the numbers fall apart. Shocking. Nobody saw that coming except everyone who has ever set foot in a real clinic.
Trials report sensitivity and AUROC numbers, then the same tests get used on patients who look nothing like the trial cohort. Who actually got biopsied to validate these scores in the real clinic, and why does nobody ask how many of those biopsies were ever done on the people the tests now screen out? Selection bias everywhere, and the press release calls it “promising.” Give me the denominator before I believe the headline.
