Major European study shows which tests could spare patients a liver biopsy
The European LITMUS programme, coordinated by Newcastle University, compared blood tests, liver stiffness scans and MRI with biopsy, the test currently used to measure fatty liver damage, in more than 1,500 patients. Several reliably detect advanced fibrosis and cirrhosis. The catch: at the stage that decides entry into drug trials only one test met the bar, and biopsy will still be needed there.
To find out how damaged a fatty liver is, doctors often still have to put a needle into the organ and take a small piece: a biopsy. Two studies from the European LITMUS programme, published in The Lancet and Nature Medicine, show which needle-free tests can take its place, and where they can’t yet.
Metabolic dysfunction-associated steatotic liver disease (MASLD) affects about a third of adults worldwide, and a far larger share of people with obesity or type 2 diabetes. With the first drugs for its severe form, MASH, reaching clinics, simple and reliable tests are needed.
Ready for cirrhosis, not yet for everything
The first study compared blood tests and liver stiffness scans in more than 1,500 patients; the second, advanced MRI in more than 350. For advanced fibrosis and cirrhosis, the most accurate were the SOMAScan protein panel, MR elastography and FibroScan elastography. The ELF and ADAPT blood tests also cleared the bar for cirrhosis.
“For advanced liver scarring and cirrhosis, we now have tools good enough to use with real confidence,” says Professor Quentin Anstee, the consortium’s coordinator.
The catch lies in the middle stage, the one that decides whether a patient can join a drug trial: there, only SOMAScan reached the set accuracy, and regulators still require a biopsy.
A cheap blood test to start with
One surprise: gamma-GT, a simple, cheap blood test, worked better as a first filter than the FIB-4 score. The authors suggest a pathway, still to be validated: gamma-GT first, then ELF or FibroScan, with advanced imaging kept for specialist clinics.
LITMUS brought together 53 partners from universities and industry, funded by the Innovative Medicines Initiative, a partnership between the European Union and Europe’s pharmaceutical industry.
