Implementation of Artificial Intelligence in Detection, Classification, and Prognostication of Osteosarcoma Utilizing Different Assessment Techniques: A Systematic Review Publisher



Z Mohamadi ZHINA ; P Partovifar PANIZ ; H Ahmadzadeh HELIA ; Ea Ahmadi Elmira ALI ; A Ghanbari ALI ; S Feyzipour SINA ; F Atefat FATEMEH ; N Jahanpeyma NAZANIN ; F Haghighi Asl FATEMEH ; A Zarinkhat ARMIN
Source: Intelligence-Based Medicine Published:2025

Abstract

Introduction: Osteosarcoma (OS) is the most common primary bone cancer particularly in individuals aged 0–19, classified into different stages. Early diagnosis improves survival, Determination of prognosis and treatment based on it, and enables limb-sparing surgery. AI, in particular machine learning (ML) and deep learning (DL), helps analyze large datasets, identify biomarkers, predict prognosis, and personalize treatments by assessing the aforementioned features. AI has the potential to improve evaluation procedures, such as imaging and pathology approaches used in OS diagnosis, prognosis, and treatment. This study systematically examines AI's synergistic role with conventional evaluating techniques in OS treatment, improving prognostication, predicting therapy responses, and developing personalized treatment strategies. Method: We performed an extensive search via several databases until April 23, 2024. Machine learning (ML), deep learning (DL) as the main branches of AI are often utilized in the medical sciences were searched for detection classification, and prognostication of osteosarcoma. RAYYAN.ai was used to screen the articles through the titles and abstracts. We conducted data extraction on the included articles and employed Cochrane and QUIPS tools to assess potential bias in the included non-prognosis and prognosis studies to evaluate their quality, respectively. Results: There were 8129 articles obtained from the four databases following a thorough search. Of them 8050 ones were excluded and the remaining 78 articles published from 2013 to 2024 were reviewed. A large number of the articles indicated moderate and low risk of bias as a result of the risk of bias assessment. The majority of the articles that were reviewed (n = 48) concerned the clinical aspects of osteosarcoma; of these, 23 and 25 studies assessed diagnosis and prognoses, respectively. Furthermore, 20 articles examined image analysis specifically, 4 examined image segmentation methods, and 16 introduced classifiers to identify osteosarcoma from other diseases. Conclusion: AI improves biomarker identification, diagnostics, and prognosis of osteosarcoma through medical imaging and data integration. Models like ResNet50 and CNN show high performance but face real-world limitations due to data heterogeneity and overfitting. This study explores AI's role in osteosarcoma diagnosis, emphasizing interdisciplinary collaboration, external validation, and real-world application challenges. © 2025 Elsevier B.V., All rights reserved.