Artificial Intelligence in CT for Predicting Cervical Lymph Node Metastasis in Papillary Thyroid Cancer Patients: A Meta-analysis.

[PURPOSE] This meta-analysis aims to evaluate the diagnostic performance of CT-based artificial intelligence (AI) in diagnosing cervical lymph node metastasis (LNM) of papillary thyroid cancer (PTC).

[METHODS] A systematic search was conducted in PubMed, Embase, and Web of Science databases through December 2024, following PRISMA-DTA guidelines. Studies evaluating CT-based AI models for diagnosing cervical LNM in patients with pathologically confirmed PTC were included. The methodological quality was assessed using a modified QUADAS-2 tool. A bivariate random-effects model was used to calculate pooled sensitivity, specificity, and area under the curve (AUC). Heterogeneity was evaluated using I statistics, and meta-regression analyses were performed to explore potential sources of heterogeneity.

[RESULTS] 17 studies comprising 1778 patients in internal validation sets and 4072 patients in external validation sets were included. In internal validation sets, AI demonstrated a sensitivity of 0.80 (95% CI: 0.71-0.86), specificity of 0.79 (95% CI: 0.73-0.84), and AUC of 0.86 (95% CI: 0.83-0.89). Radiologists suggested comparable performance with sensitivity of 0.77 (95% CI: 0.64-0.87), specificity of 0.79 (95% CI: 0.72-0.85), and AUC of 0.85 (95% CI: 0.81-0.88). Subgroup analyses revealed that deep learning methods outperformed machine learning in sensitivity (0.86 vs 0.72, P<0.05). No significant publication bias was found in internal validation sets for AI diagnosis (P=0.78).

[CONCLUSION] CT-based AI showed comparable diagnostic performance to radiologists for detecting cervical LNM in PTC patients, with deep learning models showing superior sensitivity. AI could potentially serve as a valuable diagnostic support tool, though further prospective validation is warranted. Limitations include high heterogeneity among studies and insufficient external validation in diverse populations.