MAST versus FAST for active fibrotic MASH: a meta-analysis supporting risk-stratified diagnostic pathways

Objective: This meta-analysis aimed to compare the diagnostic accuracy of two new scores-FibroScan-AST (FAST) and MRI-AST (MAST)-for identifying metabolic dysfunction-associated steatohepatitis (MASH) with significant fibrosis. Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines, with the protocol registered in PROSPERO. Four studies that compared FAST and MAST with liver biopsies were included. The combined sensitivity, specificity, diagnostic odds ratio (DOR), and area under the curve (AUC) were calculated using a bivariate random-effects model. Heterogeneity and threshold effects were assessed using subgroup and sensitivity analyses, respectively. Results: = 0.005), whereas MAST results were more consistent. Conclusion: Although MAST and FAST differ in sensitivity and stability, their overall diagnostic accuracy does not differ statistically. The core limitation of this study is that only four studies were included, which restricts the reliability of the pooled estimates. Therefore, the findings should be interpreted with caution. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251109029.