Artificial intelligence for ovarian cancer diagnosis via ultrasound: A systematic review and quantitative assessment of model performance

Igor Garcia-Atutxa^1,2Francisca Villanueva-Flores²Ekaitz Dudagotia Barrio³Javier Ignacio Sanchez-Villamil²Jose Martínez-Más⁴Andrés Bueno-Crespo^4*

• ¹Catholic University San Antonio of Murcia, Guadalupe, Spain
• ²Instituto Politecnico Nacional, Mexico City, Mexico
• ³Universidad de Murcia, Murcia, Spain
• ⁴Universidad Catolica San Antonio de Murcia, Murcia, Spain

Background: Early and accurate detection of ovarian cancer (OC) remains clinically challenging, prompting exploration of artificial intelligence (AI)-based ultrasound diagnostics. This systematic review and meta-analysis critically evaluate diagnostic accuracy, methodological rigor, and clinical applicability of AI models for ovarian mass classification using B-mode ultrasound. Methods: A systematic literature search following PRISMA guidelines was conducted in PubMed, IEEE Xplore, and Scopus up to December 2024. Eligible studies included AI-based ovarian mass classification using B-mode ultrasound, reporting accuracy, sensitivity, specificity, and/or area under the ROC curve (AUC). Data extraction, quality assessment (PROBAST), and meta-analysis (random effects) were independently performed by two reviewers. Heterogeneity sources were explored. Results: From 823 identified records, 44 studies met inclusion criteria, covering over 650,000 images. Pooled performance metrics indicated high accuracy (92.3%), sensitivity (91.6%), specificity (90.1%), and AUC (0.93). Automated segmentation significantly outperformed manual segmentation in accuracy and sensitivity, demonstrating standardization benefits and reduced observer variability. Dataset size minimally correlated with performance, highlighting methodological rigor as a primary determinant. No specific AI architecture consistently outperformed others. Substantial methodological heterogeneity and frequent risk-of-bias issues (limited validation, small datasets) currently limit clinical translation. Conclusion: AI models show promising diagnostic performance for OC ultrasound imaging. However, addressing methodological challenges, including rigorous validation, standardized reporting (TRIPOD-AI, STARD-AI), and prospective multicenter studies, is essential for clinical integration. This review provides clear recommendations to enhance clinical translation of AI-based ultrasound diagnostics.