Meta-analysis compares FAST and MAST scores for MASH with significant fibrosis diagnosis

ObjectiveThis 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.MethodsA 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.ResultsThe FAST score showed moderate sensitivity (44.7, 95% CI: 28.3–62.4%) and quite high specificity (87.5%, 76.8–93.7%), with an AUC of 0.83 (0.75–0.89). MAST showed better sensitivity (55.9%, 41.5–69.3%) and specificity (88.1%, 85.2–90.6%), with an AUC of 0.84 (0.81–0.88). The difference in the AUC was not statistically significant (p = 0.964). Compared to FAST, MAST showed a relatively higher positive likelihood ratio (4.71 vs. 3.54) and DOR (9.42 vs. 5.68), although these differences were not statistically significant. FAST showed significant threshold variability (p = 0.005), whereas MAST results were more consistent.ConclusionAlthough 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 registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420251109029.