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Meta-Analysis
. 2021 Sep 26;21(1):1058.
doi: 10.1186/s12885-021-08773-w.

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

Sergei Bedrikovetski  1   2 , Nagendra N Dudi-Venkata  3   4 , Hidde M Kroon  3   4 , Warren Seow  3 , Ryash Vather  4 , Gustavo Carneiro  5 , James W Moore  3   4 , Tarik Sammour  3   4
Affiliations
Meta-Analysis

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

Sergei Bedrikovetski et al. BMC Cancer. .

Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusion: 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.

Trial registration: PROSPERO CRD42020218004 .

Keywords: Artificial intelligence; Colorectal cancer; Deep learning; Lymph node metastasis; Machine learning; Radiomics; meta-analysis.

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Conflict of interest statement

The authors declare that they have no competing interests

Figures

Fig. 1
Fig. 1
PRISMA flow chart outlining the selection of studies for review
Fig. 2
Fig. 2
Summary of QUADAS-2 assessments of included studies
Fig. 3
Fig. 3
Forest plots of per-patient area under the receiver operating characteristic curve (AUROC). (a) Deep learning in rectal cancer, (b) radiomics in rectal cancer, (c) radiomics in colorectal cancer, (d) radiologist in rectal cancer and (e) radiologist in colorectal cancer
See this image and copyright information in PMC

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