How does deep learning/ machine learning perform in comparison to radiologists in distinguishing Glioblastomas (or grade IV Astrocytomas) from Primary CNS Lymphomas?: A meta-analysis and systematic review

Background Several studies have been published comparing deep learning (DL)/machine learning (ML) to radiologists in differentiating PCNSLs from GBMs with equivocal results. We aimed to perform this meta-analysis to evaluate the diagnostic accuracy of ML/DL versus radiologists in classifying PCNSL versus GBM using MRI. Methodology The study was performed in accordance with PRISMA guidelines. Data was extracted and interpreted by two researchers with 12 and 23 years’ experience respectively, QUADAS-2 tool was used for quality and risk-bias assessment. We constructed contingency tables to derive sensitivity, specificity accuracy, summary receiver operating characteristic (SROC) curve and the area under the curve (AUC). Results Our search identified 11 studies, of which 8 satisfied our inclusion criteria and restricted the analysis in each study to reporting the model showing highest accuracy, with a total sample size of 1159 patients. The random effects model showed a pooled sensitivity of 0.89 [95% CI:0.84 - 0.92] for ML and 0.82 [95% CI:0.76 - 0.87] for radiologists. Pooled specificity was 0.88 [95% CI: 0.84 - 0.91] for ML and 0.90 [95% CI: 0.81 - 0.95] for radiologists. Pooled accuracy was 0.88 [95% CI: 0.86 - 0.90] for ML and 0.86 [95% CI: 0.78- 0.91] for radiologists. Pooled AUC of ML was 0.94 [95% CI:0.92- 0.96]and for radiologists, it was 0.90 [95% CI: 0.84-0.93]. Conclusions MRI-based ML/DL techniques can complement radiologists to improve the accuracy of classifying GBMs from PCNSL, possibly reduce the need for a biopsy and avoid any unwanted neurosurgical resection of a PCNSL.