TY  - JOUR
AU  - Xue, Peng
AU  - Si, Mingyu
AU  - Qin, Dongxu
AU  - Wei, Bingrui
AU  - Seery, Samuel
AU  - Ye, Zichen
AU  - Chen, Mingyang
AU  - Wang, Sumeng
AU  - Song, Cheng
AU  - Zhang, Bo
AU  - Ding, Ming
AU  - Zhang, Wenling
AU  - Bai, Anying
AU  - Yan, Huijiao
AU  - Dang, Le
AU  - Zhao, Yuqian
AU  - Rezhake, Remila
AU  - Zhang, Shaokai
AU  - Qiao, Youlin
AU  - Qu, Yimin
AU  - Jiang, Yu
PY  - 2023
DA  - 2023/3/2
TI  - Unassisted Clinicians Versus Deep Learning–Assisted Clinicians in Image-Based Cancer Diagnostics: Systematic Review With Meta-analysis
JO  - J Med Internet Res
SP  - e43832
VL  - 25
KW  - deep learning
KW  - cancer diagnosis
KW  - systematic review
KW  - meta-analysis
AB  - Background: A number of publications have demonstrated that deep learning (DL) algorithms matched or outperformed clinicians in image-based cancer diagnostics, but these algorithms are frequently considered as opponents rather than partners. Despite the clinicians-in-the-loop DL approach having great potential, no study has systematically quantified the diagnostic accuracy of clinicians with and without the assistance of DL in image-based cancer identification. Objective: We systematically quantified the diagnostic accuracy of clinicians with and without the assistance of DL in image-based cancer identification. Methods: PubMed, Embase, IEEEXplore, and the Cochrane Library were searched for studies published between January 1, 2012, and December 7, 2021. Any type of study design was permitted that focused on comparing unassisted clinicians and DL-assisted clinicians in cancer identification using medical imaging. Studies using medical waveform-data graphics material and those investigating image segmentation rather than classification were excluded. Studies providing binary diagnostic accuracy data and contingency tables were included for further meta-analysis. Two subgroups were defined and analyzed, including cancer type and imaging modality. Results: In total, 9796 studies were identified, of which 48 were deemed eligible for systematic review. Twenty-five of these studies made comparisons between unassisted clinicians and DL-assisted clinicians and provided sufficient data for statistical synthesis. We found a pooled sensitivity of 83% (95% CI 80%-86%) for unassisted clinicians and 88% (95% CI 86%-90%) for DL-assisted clinicians. Pooled specificity was 86% (95% CI 83%-88%) for unassisted clinicians and 88% (95% CI 85%-90%) for DL-assisted clinicians. The pooled sensitivity and specificity values for DL-assisted clinicians were higher than for unassisted clinicians, at ratios of 1.07 (95% CI 1.05-1.09) and 1.03 (95% CI 1.02-1.05), respectively. Similar diagnostic performance by DL-assisted clinicians was also observed across the predefined subgroups. Conclusions: The diagnostic performance of DL-assisted clinicians appears better than unassisted clinicians in image-based cancer identification. However, caution should be exercised, because the evidence provided in the reviewed studies does not cover all the minutiae involved in real-world clinical practice. Combining qualitative insights from clinical practice with data-science approaches may improve DL-assisted practice, although further research is required. Trial Registration: PROSPERO CRD42021281372; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=281372 
SN  - 1438-8871
UR  - https://www.jmir.org/2023/1/e43832
UR  - https://doi.org/10.2196/43832
UR  - http://www.ncbi.nlm.nih.gov/pubmed/36862499
DO  - 10.2196/43832
ID  - info:doi/10.2196/43832
ER  -