Diagnostic performance of artificial intelligence in detecting and subtyping pediatric medulloblastoma from histopathological images: A systematic review

Background: Medulloblastoma is the most prevalent malignant brain tumor in children, requiring timely and precise diagnosis to improve clinical outcomes. Artificial Intelligence (AI) offers a promising avenue to enhance diagnostic accuracy and efficiency in this domain. Objective: This systematic review evaluates the performance of AI models in detecting and subtyping medulloblastomas using histopathological images. Methods: In this systematic review, we searched seven databases to identify English-language studies assessing AI-based detection or classification of medulloblastomas in patients under 18 years. Two reviewers independently conducted study selection, data extraction, and risk of bias assessment. Results were synthesized narratively. Results: Of 3341 records, 15 studies met inclusion criteria. AI models demonstrated strong diagnostic performance, with mean accuracy of 91.3 %, sensitivity of 94.2 %, and specificity of 97.4 %. Support Vector Machines achieved the highest accuracy (96.3 %) and specificity (99.4 %), while K-Nearest Neighbors showed the highest sensitivity (97.1 %). Detection tasks (accuracy 96.1 %, sensitivity 98.5 %) outperformed subtyping tasks (accuracy 87.3 %, sensitivity 91.3 %). Models analyzing images at the architectural level yielded higher accuracy (94.7 %), sensitivity (94.1 %), and specificity (98.2 %) compared to cellular-level analysis. Conclusion: AI algorithms show promise in detecting and subtyping medulloblastomas, but the findings are limited by overreliance on one dataset, small sample sizes, limited study numbers, and lack of meta-analysis Future research should develop larger, more diverse datasets and explore advanced approaches like deep learning and foundation models. Techniques (e.g., model ensembling and multimodal data integration) are needed for better multiclass classification. Further reviews are needed to assess AI's role in other pediatric brain tumors.