The Elucidating Pathways of Steatohepatitis (EPoS) staging system: A reproducible 7-tiered fibrosis scoring system in MASLD

The traditional 5-tiered NASH CRN system for staging metabolic dysfunction-associated steatotic liver disease (MASLD)-related fibrosis has limited resolution for advanced stages, which are most strongly associated with liver-related outcomes. The newly developed and validated EPoS expanded 7-tiered staging system provides greater granularity for advanced fibrosis and more accurately reflects fibrosis progression in MASLD. The EPoS system is expected to improve the accuracy of fibrosis staging for patient selection in MASH (metabolic dysfunction-associated steatohepatitis) clinical trials and for assessing changes in fibrosis during both natural disease progression and therapeutic interventions, as well as in routine pathology practice. In addition, we demonstrate that digital pathology slides can be reliably used for reproducible fibrosis staging in MASLD, yielding results comparable to those obtained from glass slides, with direct practical implications for liver biopsy interpretation using scanned images.