Diagnostic performance of ADC values and MRI-based radiomics analysis for detecting lymph node metastasis in patients with cervical cancer: A systematic review and meta-analysis

Objective To evaluate and compare the diagnostic performance of apparent diffusion coefficient (ADC) values and MRI-based radiomics analysis for lymph node metastasis (LNM) detection in patients with cervical cancer (CC). Methods We searched relevant databases for studies on ADC values and MRI-based radiomics analysis for LNM detection in CC between January 2001 and December 2021. Methodological quality assessment of risk of bias using Quality Assessment of Diagnostic Accuracy Studies 2 and radiomics quality score (RQS) of the studies was conducted. The pooled sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR–), diagnostic odds ratio (DOR), and area under the curve (AUC) were calculated. Diagnostic performance was compared between the two quantitative analyses using a two-sample Z-test. Results In total, 22 studies including 2314 patients were included. Unclear risk of bias was observed in 4.5–36.4% of the studies. The 8 radiomics studies exhibited a median (interquartile range) RQS of 13.5 (5.5–15.75). The pooled sensitivity, specificity, LR+, LR–, DOR, and AUC of the ADC values vs radiomics analysis were 0.86 vs 0.84, 0.85 vs 0.73, 5.7 vs 3.1, 0.17 vs 0.22, 34 vs 14, and 0.91 vs 0.86, respectively. There was no threshold effect or publication bias, but significant heterogeneity existed among the studies. No significant difference was detected in the diagnostic performance of the two quantitative analyses using the Z-test. Conclusion ADC values are more clinically promising because they are more easily accessible and widely applied, and exhibit a non-statistically significant trend to outperform radiomics analysis.