Predicting lymph node metastasis in thyroid cancer: systematic review and meta-analysis on the CT/MRI-based radiomics and deep learning models

Background

Thyroid cancer, a common endocrine malignancy, has seen increasing incidence, making lymph node metastasis (LNM) a critical factor for recurrence and survival. Radiomics and deep learning (DL) advancements offer the potential for improved LNM prediction using CT and MRI, though challenges in diagnostic accuracy remain.

Methods

A systematic review and meta-analysis were conducted per established guidelines, with searches across PubMed, Scopus, Web of Science, and Embase up to February 15, 2024. Studies developing CT/MRI-based radiomics and/or DL models for preoperative LNM assessment in thyroid cancer patients were included. Data were extracted and analyzed using R software.

Results

Sixteen studies were analyzed. In internal validation sets, sensitivity was 81.1 % (95 % CI: 75.6 %–85.6 %) and specificity 76.4 % (95 % CI: 68.4 %–82.9 %). Training sets showed a sensitivity of 84.4 % (95 % CI: 81.5 %–87 %) and a specificity of 84.7 % (95 % CI: 74.4 %–91.4 %). The pooled AUC was 86 % for internal validation and 87 % for training. Handcrafted radiomics had a sensitivity of 79.4 % and specificity of 69.2 %, while DL models showed 80.8 % sensitivity and 78.7 % specificity. Subgroup analysis revealed that models for papillary thyroid cancer (PTC) had a pooled specificity of 76.3 %, while those including other or unspecified cancers showed 68.3 % specificity. Despite heterogeneity, significant differences (p = 0.037) were noted between models with and without clinical data.

Conclusion

Radiomics and DL models show promising potential for detecting LNM in thyroid cancer, particularly in PTC. However, study heterogeneity underscores the need for further research to optimize these imaging tools.