AI-Driven Breast Cancer Diagnosis: A Systematic Review of Imaging Modalities, Deep Learning, and Explainability

Background: This article provides a comprehensive overview of recent advancements in artificial intelligence (AI) and deep-learning technologies for breast cancer (BC) diagnosis across various imaging modalities. Methods: A systematic review was conducted in strict adherence to the PRISMA guidelines, incorporating a comparative analysis of 65 peer-reviewed studies published between 2018 and 2024. The evaluation focused on diagnostic performance, architectural developments, and clinical integration strategies. Results: The review synthesizes primary findings on convolutional neural networks (CNNs), emerging architectures including graph neural networks, and hybrid models, with diagnostic accuracy, risk prediction, and personalized screening strategies identified as the leading research domains. Notable achievements include CNNs attaining up to 98.5% accuracy in mammography and Vision Transformers reaching 96% in histopathological analysis. Furthermore, the implementation of explainable AI methodologies, such as SHAP, LIME, and Grad-CAM, is emphasized for maintaining transparency, trust, and accountability in clinical decision-making. Conclusions: AI constitutes a pivotal factor in facilitating early BC diagnosis and optimizing treatment outcomes. Nevertheless, significant challenges persist, including dataset heterogeneity, model generalizability, standardization of imaging protocols, computational resource limitations, and the seamless integration of these technologies into established clinical workflows. Future research must prioritize robust multi-dataset validation and standardized implementation frameworks to overcome existing limitations and advance successful BC diagnostic practices.