Diagnostic accuracy of MRI-based radiomic features for EGFR mutation status in non-small cell lung cancer patients with brain metastases: a meta-analysis

Abstract

Objective: This meta-analysis aims to evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) based radiomic features for predicting epidermal growth factor receptor (EGFR) mutation status in non-small cell lung cancer (NSCLC) patients with brain metastases.

Methods: We systematically searched PubMed, Embase, Cochrane Library, Web of Science, Scopus, Wanfang, and China National Knowledge Infrastructure (CNKI) for studies published up to April 30, 2024. We included those studies that utilized MRI-based radiomic features to detect EGFR mutations in NSCLC patients with brain metastases. Sensitivity, specificity, positive and negative likelihood ratios (PLR, NLR), and area under the curve (AUC) were calculated to evaluate the accuracy. Quality assessment was performed using the quality assessment of prognostic accuracy studies 2 (QUADAS-2) tool. Meta-analysis was conducted using random-effects models.

Results: A total of 13 studies involving 2,348 patients were included. The pooled sensitivity and specificity of MRI-based radiomic features for detecting EGFR mutations were 0.86 (95% CI: 0.74-0.93) and 0.83 (95% CI: 0.72-0.91), respectively. The PLR and NLR were calculated as 5.14 (3.09, 8.55) and 0.17 (0.10, 0.31), respectively. Substantial heterogeneity was observed, with I² values exceeding 50% for all parameters. The AUC for the receiver operating characteristic analysis was 0.91 (95% CI: 0.88-0.93). Subgroup analysis indicated that deep learning models and studies conducted in Asian showed higher diagnostic accuracy compared to their respective counterparts.

Conclusions: MRI-based radiomic features demonstrate a high potential for accurately detecting EGFR mutations in NSCLC patients with brain metastases, particularly when advanced deep learning techniques were employed. However, the variability in diagnostic performance across different studies underscores the need for standardized radiomic protocols to enhance reproducibility and clinical utility.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42024544131.

Keywords: EGFR mutations; MRI; brain metastases; non-small cell lung cancer; radiomics.