Reply to the letter to the editor from Gao and Liu regarding ‘Non-invasive risk-based surveillance of hepatocellular carcinoma in patients with metabolic dysfunction-associated steatotic liver disease’

We thank Gao and Liu for their thoughtful comments on our study and for highlighting two important issues regarding the implementation of non-invasive test-based hepatocellular carcinoma (HCC) surveillance in patients with metabolic dysfunction-associated steatotic liver disease (MASLD).1 2 Our study was a large multicentre longitudinal cohort of 12 950 patients with MASLD, among whom 109 developed incident HCC over a median follow-up of 47.7 months. The study aimed to define practical Fibrosis-4 index (FIB-4) and liver stiffness measurement (LSM) by vibration-controlled transient elastography thresholds associated with annual HCC incidences exceeding currently accepted surveillance benchmarks.3