Artificial intelligence for pre-operative lymph node staging in colorectal cancer: a systematic review and meta-analysis

• Published in: BMC cancer Vol. 21; no. 1; p. 1058
• Main Authors: Bedrikovetski, Sergei, Dudi-Venkata, Nagendra N, Kroon, Hidde M, Seow, Warren, Vather, Ryash, Carneiro, Gustavo, Moore, James W, Sammour, Tarik
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 26.09.2021; BioMed Central; BMC
• Subjects: Accuracy; Algorithms; Artificial Intelligence; Bias; Cancer; Cancer therapies; Colorectal cancer; Colorectal carcinoma; Colorectal Neoplasms - diagnostic imaging; Colorectal Neoplasms - pathology; Computed tomography; Computer-aided medical diagnosis; Confidence intervals; Deep Learning; Diagnosis; Diagnostic imaging; Humans; Image processing; Lymph nodes; Lymph Nodes - diagnostic imaging; Lymph Nodes - pathology; Lymphatic metastasis; Lymphatic Metastasis - diagnostic imaging; Lymphatic Metastasis - pathology; Lymphatic system; Machine learning; Magnetic Resonance Imaging; Meta-analysis; Metastases; Metastasis; Methods; Neural networks; Patients; Preoperative Care; Publication Bias; Radiologists; Radiomics; Rectal Neoplasms - diagnostic imaging; Rectal Neoplasms - pathology; Rectum; ROC Curve; Segmentation; Sensitivity and Specificity; Software; Statistical analysis; Systematic review; Tomography, X-Ray Computed; Tumor staging; Australia; Deep learning; Lymph node metastasis; Colorectal cancer; Machine learning; meta-analysis; Artificial intelligence; Radiomics
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/s12885-021-08773-w

Artificial intelligence (AI) is increasingly being used in medical imaging analysis. We aimed to evaluate the diagnostic accuracy of AI models used for detection of lymph node metastasis on pre-operative staging imaging for colorectal cancer. A systematic review was conducted according to PRISMA guidelines using a literature search of PubMed (MEDLINE), EMBASE, IEEE Xplore and the Cochrane Library for studies published from January 2010 to October 2020. Studies reporting on the accuracy of radiomics models and/or deep learning for the detection of lymph node metastasis in colorectal cancer by CT/MRI were included. Conference abstracts and studies reporting accuracy of image segmentation rather than nodal classification were excluded. The quality of the studies was assessed using a modified questionnaire of the QUADAS-2 criteria. Characteristics and diagnostic measures from each study were extracted. Pooling of area under the receiver operating characteristic curve (AUROC) was calculated in a meta-analysis. Seventeen eligible studies were identified for inclusion in the systematic review, of which 12 used radiomics models and five used deep learning models. High risk of bias was found in two studies and there was significant heterogeneity among radiomics papers (73.0%). In rectal cancer, there was a per-patient AUROC of 0.808 (0.739-0.876) and 0.917 (0.882-0.952) for radiomics and deep learning models, respectively. Both models performed better than the radiologists who had an AUROC of 0.688 (0.603 to 0.772). Similarly in colorectal cancer, radiomics models with a per-patient AUROC of 0.727 (0.633-0.821) outperformed the radiologist who had an AUROC of 0.676 (0.627-0.725). AI models have the potential to predict lymph node metastasis more accurately in rectal and colorectal cancer, however, radiomics studies are heterogeneous and deep learning studies are scarce. PROSPERO CRD42020218004 .