Prediction of cervical cancer lymph node metastasis based on multisequence magnetic resonance imaging radiomics and deep learning features: a dual-center study

Cervical cancer is a leading cause of death from malignant tumors in women, and accurate evaluation of occult lymph node metastasis (OLNM) is crucial for optimal treatment. This study aimed to develop several predictive models-including Clinical model, Radiomics models (RD), Deep Learning models (DL), Radiomics-Deep Learning fusion models (RD-DL), and a Clinical-RD-DL combined model-for assessing the risk of OLNM in cervical cancer patients.The study included 130 patients from Center 1 (training set) and 55 from Center 2 (test set). Clinical data and imaging sequences (T1, T2, and DWI) were used to extract features for model construction. Model performance was assessed using the DeLong test, and SHAP analysis was used to examine feature contributions. Results showed that both the RD-combined (AUC = 0.803) and DL-combined (AUC = 0.818) models outperformed single-sequence models as well as the standalone Clinical model (AUC = 0.702). The RD-DL model yielded the highest performance, achieving an AUC of 0.981 in the training set and 0.903 in the test set. Notably, integrating clinical variables did not further improve predictive performance; the Clinical-RD-DL model performed comparably to the RD-DL model. SHAP analysis showed that deep learning features had the greatest impact on model predictions. Both RD and DL models effectively predict OLNM, with the RD-DL model offering superior performance. These findings provide a rapid, non-invasive clinical prediction method.