Artificial Intelligence-Driven MRI for Cervical Nodal Metastasis Detection in Oral Squamous Cell Carcinoma: A Hierarchical Meta-Analysis of Diagnostic Accuracy.

BACKGROUND: Artificial intelligence (AI) applied to magnetic resonance imaging (MRI) may improve detection of cervical lymph node metastases in oral squamous cell carcinoma (OSCC) but is heterogeneous. METHODS: A systematic review identified observational studies (from 2000) evaluating AI-based MRI in adults with histopathologically confirmed OSCC. Risk of bias was assessed with QUADAS-AI. Diagnostic performance was synthesized using a hierarchical bivariate model. Publication bias and certainty of evidence were assessed using Deeks' test and GRADE. RESULTS: Twelve studies were included; seven datasets (548 participants) were meta-analyzed. Pooled sensitivity was 0.72 (95% CI: 0.62-0.80) and specificity 0.79 (95% CI: 0.73-0.83), with AUC 0.82 and diagnostic odds ratio 9.42. Heterogeneity is mainly related to threshold effects. No significant publication bias was detected (p = 0.536). Evidence certainty was low. CONCLUSIONS: AI-assisted MRI shows moderate diagnostic performance. Multicenter validation is required before clinical implementation. CLINICAL RELEVANCE: AI-supported MRI may serve as an adjunctive tool to improve preoperative risk stratification of cervical lymph node metastasis in OSCC.