A Systematic Review of AI Performance in Lung Cancer Detection on CT Thorax

Background: The introduction of lung cancer screening (LCS) programmes will lead to a surge in imaging volumes and place greater demands on radiologists to provide timely and accurate interpretation. This increased workload risks overburdening a limited radiologist workforce, delaying diagnosis, and worsening burnout. Advancements in artificial intelligence (AI) models offer the potential to detect and classify pulmonary nodules without a loss in diagnostic performance. Methods: A systematic review of AI performance in lung cancer detection on computed tomography (CT) scans was conducted. Multiple databases like Medline, Embase, PubMed, and Cochrane were searched within a 12-year range from 1 January 2010 to 21 December 2022. Results: Fourteen studies were selected for this systematic review, with seven in the detection subgroup and eight in the classification subgroup. Compared to radiologists' performance in the respective articles, the AI models demonstrated a higher sensitivity (86.0-98.1% against 68-76%) but lower specificity (77.5-87% against 87-91.7%) for the detection of lung nodules. In classifying the malignancy of lung nodules, AI models generally showed a greater sensitivity (60.58-93.3% against 76.27-88.3%), specificity (64-95.93% against 61.67-84%), and accuracy (64.96-92.46% against 73.31-85.57%) over radiologists. Conclusion: AI models for the detection and classification of pulmonary lesions on CT have the potential to augment CT thorax interpretation while maintaining diagnostic accuracy and could potentially be harnessed to overcome challenges in the implementation of lung cancer screening programmes.