Deep learning-based breast cancer diagnosis in breast MRI: systematic review and meta-analysis

Abstract Objectives The aim of this work is to evaluate the performance of deep learning (DL) models for breast cancer diagnosis with MRI. Materials and methods A literature search was conducted on Web of Science, PubMed, and IEEE Xplore for relevant studies published from January 2015 to February 2024. The study was registered with the PROSPERO International Prospective Register of Systematic Reviews (protocol no. CRD42024485371). The quality assessment of diagnostic accuracy studies-2 (QUADAS2) tool and the Must AI Criteria-10 (MAIC-10) checklist were used to assess quality and risk of bias. The meta-analysis included studies reporting DL for breast cancer diagnosis and their performance, from which pooled summary estimates for the area under the curve (AUC), sensitivity, and specificity were calculated. Results A total of 40 studies were included, of which only 21 were eligible for quantitative analysis. Convolutional neural networks (CNNs) were used in 62.5% (25/40) of the implemented models, with the remaining 37.5% (15/40) hybrid composite models (HCMs). The pooled estimates of AUC, sensitivity, and specificity were 0.90 (95% CI: 0.87, 0.93), 88% (95% CI: 86, 91%), and 90% (95% CI: 87, 93%), respectively. Conclusions DL models used for breast cancer diagnosis on MRI achieve high performance. However, there is considerable inherent variability in this analysis. Therefore, continuous evaluation and refinement of DL models is essential to ensure their practicality in the clinical setting. Key Points Question Can DL models improve diagnostic accuracy in breast MRI, addressing challenges like overfitting and heterogeneity in study designs and imaging sequences ? Findings DL achieved high diagnostic accuracy (AUC 0.90, sensitivity 88%, specificity 90%) in breast MRI, with training size significantly impacting performance metrics (p < 0.001) . Clinical relevance DL models demonstrate high accuracy in breast cancer diagnosis using MRI, showing the potential to enhance diagnostic confidence and reduce radiologist workload, especially with larger datasets minimizing overfitting and improving clinical reliability .