Clarifying the decision rules and implementation boundaries for risk-based HCC surveillance in MASLD

Lai et al proposed pragmatic non-invasive thresholds to select patients with metabolic dysfunction-associated steatotic liver disease (MASLD) for hepatocellular carcinoma (HCC) surveillance via fibrosis-4 index (FIB-4) and vibration-controlled transient elastography (VCTE)-derived liver stiffness measurement (LSM).1 To make the proposed thresholds workable as a repeatable pathway in routine care, we ask the authors to clarify three practical aspects.