{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T14:59:42Z","timestamp":1791557982654,"version":"4.3.4"},"reference-count":48,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T00:00:00Z","timestamp":1760054400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T00:00:00Z","timestamp":1760054400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the clinical utility of machine learning algorithms (MLAs) in diagnosing extra\u2010nodal extension (ENE) using CT imaging in HNSCC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources<\/jats:title>\n                    <jats:p>A comprehensive literature search was conducted on MEDLINE (Ovid), EMBASE, Cochrane, Scopus, and Web of Science, from January 1, 2000, to February 12, 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Review Methods<\/jats:title>\n                    <jats:p>Two independent reviewers selected studies reporting the diagnostic accuracy of MLAs in detecting ENE in patients with HNSCC. The review followed PRISMA guidelines. Meta\u2010analysis was performed using MedCalc (23.0.2), with pooled estimates of the area under the curve (AUC) and corresponding 95% confidence intervals (CI) calculated. The Checklist for Artificial Intelligence in Medical Imaging (CLAIM) was used to analyze the methodological quality of the included studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 57 articles retrieved, six met inclusion criteria, encompassing 2870 lymph nodes from 1407 patients. MLAs achieved a pooled AUC of 0.92 (95% CI [0.915, 0.923],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001; fixed\u2010effects) and 0.91 (95% CI [0.882, 0.929],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001; random\u2010effects), outperforming radiologists who had pooled AUCs of 0.65 (95% CI [0.645\u20130.654],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001; fixed\u2010effects) and 0.65 (95% CI [0.591\u20130.708],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001; random\u2010effects). Furthermore, MLA achieved a sensitivity ranging from 66.9% to 91.2%, compared to 24% to 96.0% by radiologists. The specificity and accuracy of MLA ranged from 72% to 96.2% and 66% to 92.2%, respectively, compared to that of radiologists, which ranged from 43.0% to 96.0% and 51.5% to 88.6%, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>MLAs demonstrate superior diagnostic performance in predicting ENE in HNSCC and may serve as a valuable adjunct to radiologists in clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>1.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lary.70194","type":"journal-article","created":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T10:35:08Z","timestamp":1760092508000},"page":"1099-1108","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Machine Learning to Predict Extranodal Extension in Head and Neck Squamous Cell Carcinoma: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1002","volume":"136","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-5476-1815","authenticated-orcid":false,"given":"Arshbir","family":"Aulakh","sequence":"first","affiliation":[{"name":"MD Undergraduate Program Faculty of Medicine, University of British Columbia  Vancouver Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masih","family":"Sarafan","sequence":"additional","affiliation":[{"name":"MD Undergraduate Program Faculty of Medicine, University of British Columbia  Vancouver Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amardeep S.","family":"Sekhon","sequence":"additional","affiliation":[{"name":"MD Undergraduate Program Faculty of Medicine, University of British Columbia  Vancouver Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khanh Linh","family":"Tran","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology\u2010Head and Neck Surgery Faculty of Medicine University of British Columbia  Vancouver Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ameen","family":"Amanian","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology\u2010Head and Neck Surgery Faculty of Medicine University of British Columbia  Vancouver Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farahna","family":"Sabiq","sequence":"additional","affiliation":[{"name":"Department of Radiology Faculty of Medicine University of British Columbia  Vancouver Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cornelius","family":"K\u00fcrten","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology\u2010Head and Neck Surgery Faculty of Medicine University of British Columbia  Vancouver Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7201-6181","authenticated-orcid":false,"given":"Eitan","family":"Prisman","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology\u2010Head and Neck Surgery Faculty of Medicine University of British Columbia  Vancouver Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,10,10]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21389"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-031-23175-9_7"},{"issue":"1","key":"e_1_2_10_4_1","first-page":"E1192","article-title":"Influence of Extracapsular Nodal Spread Extent on Prognosis of Oral Squamous Cell Carcinoma","volume":"38","author":"Wreesmann V. B.","year":"2016","journal-title":"Head and Neck"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2013.2666"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.26796"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2016.08.004"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2020.104845"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2015.11.006"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.20279"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.21.01752"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.165.3.3317494"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(24)00066-4"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2013.4491"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1148\/rg.2017160130"},{"key":"e_1_2_10_16_1","first-page":"3642","article-title":"Multi\u2010Column Deep Neural Networks for Image Classification","volume":"2012","author":"Ciregan D.","year":"2012","journal-title":"IEEE Conference on Computer Vision and Pattern Recognition"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1158\/1078-0432.CCR-17-2236"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1038\/nature21056"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.1095"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-019-0447-x"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1038\/nature14539"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2589-7500(23)00046-8"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-018-32441-y"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_10_25_1","first-page":"234","article-title":"Artificial Intelligence and Lymphedema: State of the Art","volume":"8","author":"Eldaly A. S.","year":"2022","journal-title":"J Clin Transl Res"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.7326\/ACPJC-1995-123-3-A12"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1148\/ryai.2020200029"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.143.1.7063747"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.1186"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.315.7109.629"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.2307\/2533446"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11282-019-00391-4"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40644-023-00601-7"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.19.02031"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1002\/mp.16680"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2021.02.024"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.26281"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.health.2023.100216"},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.1109\/TTS.2023.3234203"},{"key":"e_1_2_10_40_1","doi-asserted-by":"publisher","DOI":"10.1109\/ACCESS.2017.2788044"},{"key":"e_1_2_10_41_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-023-09407-4"},{"key":"e_1_2_10_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2022.105716"},{"key":"e_1_2_10_43_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.35815"},{"key":"e_1_2_10_44_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.27130"},{"key":"e_1_2_10_45_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.27183"},{"key":"e_1_2_10_46_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.19.03309"},{"key":"e_1_2_10_47_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.20.00275"},{"key":"e_1_2_10_48_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.32667"},{"key":"e_1_2_10_49_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11604-020-00929-1"}],"container-title":["The Laryngoscope"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lary.70194","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/lary.70194","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lary.70194","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T12:13:50Z","timestamp":1772972030000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/lary.70194"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,10]]},"references-count":48,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1002\/lary.70194"],"URL":"https:\/\/doi.org\/10.1002\/lary.70194","archive":["Portico"],"relation":{},"ISSN":["0023-852X","1531-4995"],"issn-type":[{"value":"0023-852X","type":"print"},{"value":"1531-4995","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,10]]},"assertion":[{"value":"2025-05-28","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-29","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-10","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}