Imaging Based Artificial Intelligence for Predicting Lymph Node Metastasis in Cervical Cancer Patients: A Systematic Review and Meta-Analysis

Chu-Qian Jiang ^1,2,3 Xiu-Juan Li ^1,2,3 Zhi-Yi Zhou ^1,2,3 Qing Xin ^1,2,3 Lin Yu ^1,2*

• ¹ Department of Obstetrics, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated hospital of Guangzhou Medical University, Guangzhou, China
• ² Department of Obstetrics and Gynecology, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, Guangzhou, China
• ³ Department of Clinical Medicine, The Third Clinical School of Guangzhou Medical University, Guangzhou, China

Purpose: This meta-analysis was conducted to assess the diagnostic performance of artificial intelligence (AI) based on imaging for detecting lymph node metastasis (LNM) among cervical cancer patients and to compare its performance with that of radiologists.Methods: A comprehensive literature search was conducted across PubMed, Embase, and Web of Science to identify relevant studies published up to October 2024. The search followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Diagnostic Test Accuracy (PRISMA-DTA) guidelines. Studies evaluating the accuracy of AI models in detecting LNM in cervical cancer through computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography/computed tomography (PET/CT) were included. Pathology served as the reference standard for validation. A bivariate random-effects model was employed to estimate pooled sensitivity and specificity, both presented alongside 95% confidence intervals (CIs). Bias was assessed with the revised Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Study heterogeneity was examined through the I2 statistic. Meta-regression was conducted when significant heterogeneity (I2 > 50%) was observed.Results: A total of 23 studies were included in this meta-analysis. The quality and bias of the included studies were acceptable. However, substantial heterogeneity was observed among the included studies. Internal validation sets comprised 23 studies and 1,490 patients. The pooled sensitivity, specificity, and the area under the curve (AUC) for detecting LNM in cervical cancer were 0.83 (95% CI: 0.78-0.87), 0.78 (95% CI: 0.74-0.82) and 0.87 (95% CI: 0.84-0.90), respectively. External validation sets comprised six studies and 298 patients. The pooled sensitivity, specificity, and AUC for detecting LNM were 0.70 (95% CI: 0.56-0.81), 0.85 (95% CI: 0.66-0.95) and 0.76 (95% CI: 0.72-0.79), respectively. For radiologists, eight studies and 644 patients were included; the pooled sensitivity, specificity, and AUC for detecting LNM were 0.54 (95% CI: 0.42-0.66), 0.79 (95% CI: 0.59-0.91) and 0.65 (95% CI: 0.60-0.69), respectively.Conclusions: Imaging-based AI demonstrates higher diagnostic performance than radiologists. Prospective studies with rigorous standardization as well as further research with external validation datasets, are necessary to confirm the results and assess their practical clinical applicability.