Artificial Intelligence Assisted 18F-FDG PET Radiomics in Classifying Histological Subtypes of Lung Cancer: Systematic Review and Meta-analysis.

UNLABELLED: AI-assisted radiomics is an emerging tool for precision oncology, and many studies have recently shown promising results. However, there are still differences in whether it can be applied in clinical practice. This study aimed to evaluate the diagnostic accuracy of PET-based radiomics in ML models for histological subtype classification of lung cancer through a systematic review and meta-analysis. The study protocol was registered in PROSPERO, CRD42024603590. Methodological quality and risk of bias were assessed using QUADAS-2 and RQS. For the meta-analysis, validation data statistics were extracted from the studies with Type 2a or above as per the TRIPOD statement. A random-effects model was used to estimate the overall effect size. Statistical heterogeneity was assessed using the I 2 value. Fourteen studies were included in the systematic review, of which eight were eligible for meta-analysis. All the studies were performed with internal validation. The average RQS across studies was 10.47 ± 4.72. Pooled sensitivity, specificity, and diagnostic odds ratio (DOR) were 0.81 (95% CI 0.65-0.90), 0.79 (95% CI 0.75-0.83), and 22.42 (95% CI 9.04-55.59), respectively. The SROC curve suggested good diagnostic performance with an AUC of 0.89 (95% CI 0.83-0.95). The meta-analysis revealed significant heterogeneity using Cochrane's Q test with p < 0.001. ML models utilizing 18F-FDG PET radiomics have the potential to predict histological subtypes of non-small cell lung cancer. External validation studies could provide stronger evidence for the generalizability. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s13139-025-00922-4.