Sonneveld MJ, et al. - In this investigation, researchers studied and optimized the performance of two non-invasive indices for ruling out cirrhosis: the aspartate aminotransferase-platelet ratio index (APRI) and fibrosis score based on four factors (FIB-4). Using data from all consecutive biopsied patients from two tertiary referral hospitals in the Netherlands and Canada, the authors externally validated the new cutoffs. Due to elevated misclassification rates, conventional cutoffs for APRI and FIB-4 should not be used to guide patient management with chronic hepatitis B. Subgroup analysis showed that the new FIB-4 cutoff was acceptable in all subgroups with the exception of individuals aged 30 or younger. A newly identified and externally validated cutoff for FIB-4 (≤0·70) can be used in patients over 30 years of age to exclude cirrhosis.