Artificial intelligence in ovarian cancer histopathology: a systematic review

Abstract

This study evaluates the quality of published research using artificial intelligence (AI) for ovarian cancer diagnosis or prognosis using histopathology data. A systematic search of PubMed, Scopus, Web of Science, Cochrane CENTRAL, and WHO-ICTRP was conducted up to May 19, 2023. Inclusion criteria required that AI was used for prognostic or diagnostic inferences in human ovarian cancer histopathology images. Risk of bias was assessed using PROBAST. Information about each model was tabulated and summary statistics were reported. The study was registered on PROSPERO (CRD42022334730) and PRISMA 2020 reporting guidelines were followed. Searches identified 1573 records, of which 45 were eligible for inclusion. These studies contained 80 models of interest, including 37 diagnostic models, 22 prognostic models, and 21 other diagnostically relevant models. Common tasks included treatment response prediction (11/80), malignancy status classification (10/80), stain quantification (9/80), and histological subtyping (7/80). Models were developed using 1-1375 histopathology slides from 1-776 ovarian cancer patients. A high or unclear risk of bias was found in all studies, most frequently due to limited analysis and incomplete reporting regarding participant recruitment. Limited research has been conducted on the application of AI to histopathology images for diagnostic or prognostic purposes in ovarian cancer, and none of the models have been demonstrated to be ready for real-world implementation. Key aspects to accelerate clinical translation include transparent and comprehensive reporting of data provenance and modelling approaches, and improved quantitative evaluation using cross-validation and external validations. This work was funded by the Engineering and Physical Sciences Research Council.

Fig. 1. PRISMA 2020 flowchart.

PRISMA 2020 flowchart of the study identification and selection process for the systematic review. Records were screened on titles and abstracts alone, and reports were assessed based on the full-text content. CENTRAL Central Register of Controlled Trials. WHO-ICTRP World Health Organisation International Clinical Trial Registry Platform.

Fig. 2. PROBAST risk of bias results.

PROBAST risk of bias results summarised for the 45 papers included in this review.

Fig. 3. Number of patients and slides per model.

Histograms showing the number of a ovarian cancer patients and b ovarian cancer histopathology slides used in model development. Many of these values are uncertain due to incomplete reporting, as reflected in Table 2.