Artificial intelligence in cytopathological applications for cancer: a review of accuracy and analytic validity

Cytopathological examination serves as a tool for diagnosing solid tumors and hematologic malignancies. Artificial intelligence (AI)-assisted methods have been widely discussed in the literature for increasing sensitivity, specificity and accuracy in the diagnosis of cytopathological clinical samples. Many of these tools are also used in clinical practice. There is a growing body of literature describing the role of AI in clinical settings, particularly in improving diagnostic accuracy and providing predictive and prognostic insights.

A comprehensive search for this systematic review was conducted using databases Google, PUBMED (n = 450) and Google Scholar (n = 1067) with the keywords "Artificial Intelligence" AND "cytopathological" and "fine needle aspiration" AND "Deep Learning" AND "Machine Learning" AND "Hematologic Disorders" AND "Lung Cancer" AND "Pap Smear" and "cervical cancer screening" AND "Thyroid Cancer" AND "Breast Cancer" and "Sensitivity" and "Specificity". The search focused on literature reviews and systematic reviews published in English language between 2020 and 2024. PRISMA guidelines were adhered to with studies included and excluded as depicted in a flowchart. 417 results were screened with 34 studies were chosen for this review.

In the screening of patients with cervical cancer, bone marrow and peripheral blood smears and benign and malignant lesions in the lung, AI-assisted methods, particularly machine learning and deep learning (a subset of machine learning) methods, were applied to cytopathological data. These methods yielded greater diagnostic accuracy, specificity and sensitivity and decreased interobserver variability. Data sets were collected for both training and validation. Human machine combined performance was also found to be comparable to standalone performance in comparison with medical performance as well.

The use of AI in the analysis of cytopathological samples in research and clinical settings is increasing, and the involvement of pathologists in AI workflows is becoming increasingly important.