Considerations and clinical utility of referral pathways for early detection of liver disease in at-risk populations

Table 6 Confirmatory non-invasive tests to diagnose advanced liver disease when the primary non-invasive test is inconclusive

	Rule out	Rule in
2021 EASL NIT clinical practice guideline	LSM: < 8 kPa	LSM: ≥ 8 kPa
	Alternatives: ELF, FibroMeter, Fibrotest	Alternatives: ELF, FibroMeter, Fibrotest
2021 AGA clinical care pathway	LSM: < 8 kPa	LSM: ≥ 12 kPa
	Alternatives: SWE, ultrasound	Alternatives: SWE, ultrasound
2023 AASLD practice guidance	LSM: < 8 kPa	LSM: ≥ 8 kPa
		Alternatives: ELF
2024 EASL-EASD-EASO clinical practice guideline	LSM: < 8 kPa	LSM: ≥ 8 kPa
		Alternatives: MRE, SWE or ELF with adjusted thresholds
2025 APASL clinical practice guideline	Not mentioned	LSM: ≥ 12 kPa, SWE ≥ 8 kPa, MRE ≥ 3.6 kPa, ELF ≥ 9.8, ADAPT ≥ 6.328

EASL: European Association for the Study of the Liver; NIT: Non-invasive test; AGA: American Gastroenterological Association; EASD: European Association for the Study of Diabetes; EASO: European Association for the Study of Obesity; APASL: Asian Pacific Association for the Study of Liver; AASLD: American Association for the Study of Liver Diseases; ELF: Enhanced liver fibrosis; SWE: Shear wave elastography; MRE: Magnetic resonance elastography; ADAPT: Age, diabetes, N-terminal propeptide of type III collagen and platelets panel; LSM: Liver stiffness measurement.