Application of artificial intelligence in ultrasound imaging for predicting lymph node metastasis in breast cancer: A meta-analysis

Abstract

BackgroundThis study aims to comprehensively evaluate the accuracy and effectiveness of ultrasound imaging based on artificial intelligence algorithms in predicting lymph node metastasis in breast cancer patients through a meta-analysis. MethodsWe systematically searched PubMed, Embase, and Cochrane Library for literature published up to May 2023. The search terms included artificial intelligence, ultrasound, breast cancer, and lymph node. Studies meeting the inclusion criteria were selected, and data were extracted for analysis. The main evaluation indicators included sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and area under the curve (AUC). The heterogeneity was assessed using the Cochrane Q test combined with the I^2 statistic expressing the percentage of total effect variation that can be attributed to the effect variation between studies, as recommended by the Cochrane Handbook for heterogeneity quantification. A threshold p-value of 0.10 was considered to compensate for the low power of the Q test. Sensitivity analysis was performed to assess the stability of individual studies, and publication bias was determined with funnel plots. Additionally, fagan plots were used to assess clinical utility. ResultsTen studies involving 4726 breast cancer patients were included in the meta-analysis. The results showed that ultrasound imaging based on artificial intelligence algorithms had high accuracy and effectiveness in predicting lymph node metastasis in breast cancer patients. The pooled sensitivity was 0.88 (95% CI: 0.81–0.93; P < 0.001; I2 = 84.68), specificity was 0.75 (95% CI: 0.66–0.83; P < 0.001; I2 = 91.11), and AUC was 0.89 (95% CI: 0.86–0.91). The positive likelihood ratio was 3.5 (95% CI: 2.6–4.8), negative likelihood ratio was 0.16 (95% CI: 0.10–0.26), and diagnostic odds ratio was 23 (95% CI: 13–40). However, the combined sensitivity of ultrasound imaging based on non-AI algorithms for predicting lymph node metastasis in breast cancer patients was 0.78 (95%CI: 0.63–0.88), the specificity was 0.76 (95%CI: 0.63–0.86), and the AUC was 0.84 (95%CI: 0.80–0.87). The positive likelihood ratio was 3.3 (95% CI: 1.9–5.6), the negative likelihood ratio was 0.29 (95% CI: 0.15–0.54), and the diagnostic odds ratio was 11 (95% CI: 4–33). Due to limited sample size (n = 2), meta-analysis was not conducted for the outcome of predicting lymph node metastasis burden. ConclusionUltrasound imaging based on artificial intelligence algorithms holds promise in predicting lymph node metastasis in breast cancer patients, demonstrating high accuracy and effectiveness. The application of this technology helps in the diagnosis and treatment decisions for breast cancer patients and is expected to become an important tool in future clinical practice.