Received: 28 June 2023 | Revised: 8 December 2023 | Accepted: 16 January 2024

DOI: 10.1111/jcmm.18144

REVIEW

A systematic review on deep learning-­based automated cancer

diagnosis models

Ritu Tandon1 | Shweta Agrawal2 | Narendra Pal Singh Rathore3 | Abhinava K. Mishra4 |
Sanjiv Kumar Jain5

1
SAGE University, Indore, India
2
Indore Institute of Science and
Abstract
Technology, Indore, India Deep learning is gaining importance due to its wide range of applications. Many re-
3
Acropolis Institute of Technology & searchers have utilized deep learning (DL) models for the automated diagnosis of can-
Research, Indore, India
4 cer patients. This paper provides a systematic review of DL models for automated
Molecular, Cellular and Developmental
Biology Department, University of diagnosis of cancer patients. Initially, various DL models for cancer diagnosis are pre-
California Santa Barbara, Santa Barbara,
sented. Five major categories of cancers such as breast, lung, liver, brain and cervical
California, USA
5
Electrical Engineering Department, Medi-­ cancer are considered. As these categories of cancers have a very high percentage of
Caps University, Indore, India occurrences with high mortality rate. The comparative analysis of different types of
Correspondence DL models is drawn for the diagnosis of cancer at early stages by considering the lat-
Abhinava K. Mishra, Molecular, Cellular est research articles from 2016 to 2022. After comprehensive comparative analysis,
and Developmental Biology Department,
University of California Santa Barbara, it is found that most of the researchers achieved appreciable accuracy with imple-
Santa Barbara, California, USA. mentation of the convolutional neural network model. These utilized the pretrained
Email: abhinavamishra@ucsb.edu
models for automated diagnosis of cancer patients. Various shortcomings with the ex-
Sanjiv Kumar Jain, Electrical Engineering
isting DL-­based automated cancer diagnosis models are also been presented. Finally,
Department, Medi-­C aps University,
Indore, Madhya Pradesh, India. future directions are discussed to facilitate further research for automated diagnosis
Email: sanjivkj@gmail.com
of cancer patients.

KEYWORDS
cancer diagnosis, CNN, deep learning, machine learning, medical imaging, RNN

1 | I NTRO D U C TI O N magnetic resonance imaging (MRI), X-­ray and computed tomogra-

Cancer is considered as one of the most dangerous diseases in the
world. Cancer is caused by the combination of genetic, environmen-
tal and lifestyle factors. In developing countries such as India, can-
cer is responsible for the maximum mortality rate with about 0.3%
death per year.1 For the correct diagnosis and treatment planning
early detection of cancer plays a very important role. It is a tedious
task for the radiologists, oncologists and pathologists. Detection of
cancer at the initial stages can improve the percentage rate of cured
patients and hence the survival rate. Medical imaging techniques like
phy (CT) are used most widely by medical practitioners for detecting
cancer. 2 Detecting cancer manually through biopsy images may be
biased and may have varied opinions from doctors to doctors de-
pending on their expertise and the parameters like exact and correct
quantitative procedures to classify the images as normal or cancer-
ous one. Automated system to identify cancer through microscopic
images can play a significant role to reduce human errors, depen-
dency and time and can provide better results.3
Use of Machine Learning (ML) algorithms for cancer detec-
tion with medical imaging and feature extraction is gaining high

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© 2024 The Authors. Journal of Cellular and Molecular Medicine published by Foundation for Cellular and Molecular Medicine and John Wiley & Sons Ltd.

J Cell Mol Med. 2024;28:e18144.  wileyonlinelibrary.com/journal/jcmm | 1 of 20

https://doi.org/10.1111/jcmm.18144
2 of 20 | TANDON et al.
popularity. So, for detecting the different types of cancers like breast,
lung, skin, liver, cervical and brain, various types of feature extraction
techniques have been reviewed in medical imaging.4,5 The previous
studies show that the techniques used for feature descriptors from
medical imaging expending the ML techniques have certain limita-
tions, resulting in under performance of the software system.6 Deep
Learning (DL) is a sub domain of ML with the extra characteristics of
learning features directly through the available data set. Recent re-
search shows that using the CNN model, DL techniques achieved im-
proved accuracy for various types of cancer detection and diagnosis. 7
In the real world, the most difficult task is to collect massive
amounts of data in a variety of formats from a number of sources.
When data are in unstructured format, traditional database man-
agement systems struggle to extract knowledge from it. It becomes
necessary to manage both structured and unstructured data in order
to create an effective system. Here, big data technology solves the
problem by extracting knowledge from both structured and un-
8
structured data.
The present review work provides a comprehensive and sys-
tematic review of automated computational deep learning-­b ased
models for cancer diagnosis. In addition, a thorough comparison
of competitive automated computational models for cancer diag-
nosis is also considered. Discussion on different tools employed in
developing automated computational models for cancer diagnosis
is drawn. Further, identification and presentation of the shortcom-
ings of competitive automated computational models for cancer
diagnosis is included. Lastly, discussions on potential future re-
search directions in the field of automated cancer diagnosis mod-
els is given.
Research questions:
The main purpose of this systematic review is to analyse reviews
and surveys published between 2016 and 2022 in the area of deep
learning in medical imaging. In doing so, we defined the following
main research questions for our study:
1. Which deep learning-­based learning technique has consistently
produced noteworthy prediction outcomes?
2. Which cancer, type of data and imaging techniques are used for
cancer nodule detection.
3. Which AI-­based methods have consistently produced noteworthy
prediction outcomes?
4. Which objective is mostly used to find the role of deep learning in
cancer prediction?
5. Which data set and mode (online and offline) are mostly used in
prediction of cancer?
Main contribution:
The main contributions of this study are as follows:
1. A systematic review of various automated computational deep
learning-­based cancer diagnosis models is presented.
2. Comparison are drawn among competitive automated computa-
tional cancer diagnosis models.
3. Various tools that have been used to build automated computa-
tional models are also discussed.
4. Various shortcomings of the competitive automated computa-
tional cancer diagnosis models are presented.
5. Finally, future research directions in the field of automated cancer
diagnosis models are discussed.
1.1 | Image processing for cancer
detection and diagnosis
Image processing techniques are being used widely in various do-
mains of medicine. It includes disease detection, patient history
analysis, drug discovery, conversation analysis, cancer detection and
identifying cancer stages. From these stages noise removal, image
enhancement and image segmentation from the medical images like
CT scans and MRI are critical steps to decide the right treatment
at the right time. Bhaskar Rao et al. used Berkeley wavelet trans-
formation based segmentation method for reducing the image seg-
mentation complexity process and improving the performance for
brain tumour detection. Relevant features are extracted from each
segmented region using the support vector machine classifier. Their
experimental result showed an accuracy of 95.61%.9 Wason et al.
presented the image processing technique for detecting lung cancer
through CT images at an early stage. By using extracted features a
classification model is applied to classify the tumour as benign or
malignant.10 Figure 1 shows the various stages of image processing.
1.2 | Artificial neural network (ANN)
Human brain has millions of neurons, which are the basic unit of
the brain and the nervous system. These neurons receive sensory
inputs via dendrites, process these inputs and output is produced
through axons. ANN is a system inspired by the human brain that
mimics human brain's behaviour in terms of learning new things
that replicate the way humans learn. These neural networks learn
from the examples and the experience and they do not require any
set of instructions or the programming to perform any task. ANN
consists of layers which are input, output and hidden layers. The
number of hidden layers may vary depending upon architecture
and application requirements. Mao et al. presented the evolu-
tion, working principle and properties of artificial neural networks
(ANNs), as well as the current state of research into the use of
ANNs in the detection and diagnosis of gastrointestinal and liver
malignancies.11
1.3 | DL in cancer detection and diagnosis
DL is a sub domain of ML and simulates the behaviour of human
brain for learning patterns and data processing for taking decisions.
DL is also termed as deep neural network or ANN with more hidden
TANDON et al.
F I G U R E 1 Schematics of steps in image processing for cancer detection.
layers and complex structure.11 Many studies have been employed
in detection of cancer using different approaches and models of
image processing and DL. Due to the availability of huge medical
data, systems with high computational power and GPUs the devel-
opments of learning algorithms utilizing DL is gaining importance for
disease diagnosis in the healthcare sector and particularly in oncol-
ogy care.12 The features of DL like image segmentation, image label-
ling, pattern recognition and object detection makes it suitable for
applications in radiology.
DL techniques are widely used for tumour, lesion detection,
classification and image segmentation. Stacked Ensemble Model
(stacking of bagged and boosted learners) for disease diagnosis
automation is proposed by authors.13 M. Coccio et al. presented a
review on use of DL algorithms in health informatics and analysed
various benefits and potential consequences of these algorithms.14
Gupta et al. presented and compared various deep learning models
for prediction and diagnosis of colon cancer. Deep auto encoders
had the highest performance with 97% accuracy and 95% area under
curve-­receiver operating characteristic (AUC-­ROC).15 Kanavati et al.
presented the classification of WSIs of LBC specimens into malig-
nant and non-­neoplastic using a deep learning model. For the same a
data set of 1605 cervical WSIs are used.16
1.4 | Convolutional neural network (CNN)
CNN is a DL algorithm that is popular in computer vision applica-
tions and applicable to varied domains of healthcare. CNN is gaining
popularity in image processing because of its dimensionality reduc-
tion characteristics. CNN is composed of convolution layers, pooling
layers and fully connected layers which learn features in hierarchical
manner through back propagation.14 CNN in radiology studies show
that for feature extraction, hand crafted techniques such as texture
analysis and the conventional ML classifier support vector machine
are used. Whereas CNN does not require hand crafted feature ex-
traction from the images and the manual segmentation of images for
finding of any tumour.
| 3 of 20
Radiologists have a large amount of data and extraction for region
of interest and features of the tumour as quantitative parameters is
shown in Figure 2. As the features are expressed by continuous vari-
ables, so it has the potential to capture more features as compared to
the visual assessment. CNNs are suitable for these cases of medical
imaging for radiologists because of the huge amount of data availability
and large number of features.17 Use of a pruned CNN model is pro-
posed for the diagnosis of Lumbar Spondylitis in.18 The other advan-
tage of CNN is automatic extraction of features through input images.
In the following section, discussion regarding the methodology
used for cancer identification is presented. Section 3 presents a
comprehensive review of breast cancer, lung cancer, brain cancer
and liver cancers. Section 4 focuses on the discussion for prediction
outcomes based on deep learning techniques. Finally, Sections 5 and
6 addresses the challenges encountered throughout the research
with key findings summarization and proposed future research
directions.
2 | R E L ATE D WO R K
2.1 | Process flow for the DL based data analysis
This systematic review presents the use of DL techniques for the
five major types of cancers: breast cancer, lung cancer, brain cancer,
cervical cancer and liver cancer. Figure 3 shows the process flow of
review analysis (PRISMA) for included articles.
The methodology of review consists following steps:
2.1.1 | Step 1. Data collection
Five databases, that is, Elsevier, Scopus, Springer Nature, Wiley and
Institute of Electrical and Electronic Engineers (IEEE) Digital Library
were searched from 2016 to 2022. Figures 4 and 5 show the data-
bases and articles considering cancer detection using DL within this
period from various databases and countries.
4 of 20 | TANDON et al.

F I G U R E 2 Schematics of feature extraction and diagnosis with large data set ROI finding.

F I G U R E 3 Process flow of review

analysis (PRISMA) for included articles.

244
216
No of Arcles

97
63 57

Elsevier IEEE Springer Nature Nature Porolio Wiley

F I G U R E 4 Summary of selected articles from five databases.

TANDON et al.
310
236
No of Arcles
USA China
F I G U R E 5 Top Five countries with publications related to automated cancer diagnosis.
1. Search Terms: For survey defined search terms were as follows:
‘computer vision’ or ‘machine vision’ or ‘artificial intelligence’ or
‘machine learning’ or ‘DL’ AND breast cancer or lung cancer
or cervical cancer or brain tumour or liver cancer.
2. Inclusion criteria: To search the relevant articles, first the titles and
abstracts were searched. Once meeting the search terms criteria
and then duplicate papers were removed.
3. Exclusion criteria: Articles that did not present techniques of can-
cer detection and diagnosis through DL were excluded from the
study.
2.1.2 | Step 2. Data analysis
In this review work a total of 686 papers were selected from Web of
Science (WoS) collection. Data analysis is performed with following
considerations,
1. Year of Publication: As DL for cancer detection has mostly attracted
researchers from the past decades, publications from 2016 to
2022 for cancer detection using deep learning is considered.
2. Purpose of the study: Different types of task performed by DL for
selecting the types of cancers such as lesion detection, classifica-
tion, segmentation etc. is considered.
3. Image Acquisition Technique: The types of medical imaging techniques
such as MRI, CT scan and chest X-­ray are used in different studies.
4. DL Architecture: Considered DL architectures such as CNN, Deep
belief network, Fast CNN and Recurrent Neural Network are the
important architectures in the field of medical for various types of
applications.
5. Image Data set: Various types of Image data sets for cancer detec-
tion and diagnosis is presented and summarized.
2.1.3 | Step 3. Application domain
1. Studies from different domains that have been implemented
using various DL models for cancer diagnostics are summarized
in Figure 6.
| 5 of 20
90
55
38
England India Germany
3 | U S E O F D L TEC H N I Q U E S FO R TH E
C A N C E R S D I AG N OS I S
3.1 | Breast cancer
In recent years, various DL applications for breast cancer detec-
tion and diagnosis have been used. Albayrak et al. implemented
feature extraction algorithm using DL models with accuracy of
96% to detect mitosis in histopathological images of breasts.19 An
image of MRI scan of normal and cancerous breast is shown in
Figure 7.
Spanhol et al. presented CNN model for classifying breast his-
topathological images through Break-­His data set. Authors utilized
AlexNet architecture for design and implementation of CNN for
differentiating benign tumours and malignant tumours. 20 A deep
network for detection of mitosis for cancer detection using breast
histology images by training a fully convolutional network (FCN)
model to take out mitosis from the whole histology images is pro-
posed by Chen et al. 21 Albarqouni et al. presented a deep convo-
lutional network for nonexpert crowd explanation in biomedical
context. The authors developed multiscale CNN architecture to
present crowd annotations. 22 A method by using unlabeled data for
learning the features hierarchy and learned features for performing
two different tasks that are breast density segmentation and scoring
of mammographic texture is presented by Kallenberg et al. 23
Selvathi et al. used mammogram images using an unsuper-
vised method of deep learning for breast cancer detection.
Stacked auto encoder and Softmax classifier were used to form
deep networks. 24 Habibzadeh et al. proposed the Res-­N et archi-
tecture of CNN to detect breast cancer with specific settings as
compared to the conventional approach. The accuracy of the pro-
posed Res-­N et architecture is 99.8% and 99.7% for benign and
malignant breast cancer. 25 A classification model for categorizing
whole side images (WSI) in breast biopsies in different diagnos-
tic classes is proposed by Gecer et al. 26 Authors have used the
FCNN classifier for labelling of the WSI. Xie et al. have adapted
Inception_V3 and Inception_ResNet_V2 architectures to classify
breast cancer histopathological image for the binary-­ and multi-
class issues by utilizing transfer learning techniques. Results show
that the classification of breast cancer using Inception_V3 and
6 of 20 | TANDON et al.

No fo Arcles
Engineering Computer Medical Computer Mathma cal
Biomedical Science Informa cs Science Computa onal
informa on Biology
system
Axis Title

F I G U R E 6 Application domains of deep learning models for cancer detection.

(A) (B)

F I G U R E 7 (A). Normal Breast (B). Breast malignant mass. Arrow indicate the malignant mass.

Inception_ResNet_V2 is superior to the existing methods. 27 Le 3.2 | Lung cancer

et al. formed a map of WSI that is providing patterns and spatial
distribution of lymphocytic infiltrates and improving quantifica-
tion of TILs. Authors have used three CNN architectures that are
Resnet-­3 4, Inception v4 and VGG16 for TILs analysis and segmen-
tation. 28 Kaur et al. used Mini-­M IAS data set consisting of 322
images and using K-­m ean clustering. Results showed appreciable
accuracy with K-­M ean clustering and MSVM as compared to de-
cision trees model. 29
Toğaçar et al. reconstructed the data set for the processing of
the auto encoder model and showed 95.89% classification success
rate.30 A KNN algorithm along with an auto encoder is used for
31
the detection of breast cancer disease with 91.24% accuracy in.
Gandomkar et al. proposed a Deep Residual Network model con-
sisting of 152 layers to classify the images as benign or malignant
and achieved classification accuracy of 98.52%, 97.90% and 98.33%,
32
respectively. A CNN model for early detection of cancer using
thermal breast images optimized by bays algorithm and achieved ac-
curacy of 98.95%.33,34
Voting classifier (VC), logistic regression (LR), decision tree (DT),
random forest (RF), support vector machine (SVM), and a propri-
etary convolutional neural network were used to construct predic-
tion models (CNN) by Mohammad Monirujjaman et al. and realized
an average accuracy of 99%35,36 Table.1.
Early detection of lung cancer may be done through the various
imaging techniques like chest X-­ray, CT scan and MRI. For the de-
tection of respiratory disease X-­ray imaging is the commonly used
technique.37,38 A representative image is provided in Figure 8.
In the CT scans multiple doses of radiation can increase the
chances of cancer. So, Wei presented an adaptive partial differential
equation model to reconstruct the images using fewer CT images
to decrease the radiation dose.39 Capizzi et al. used the fuzzy sys-
tem with the neural network for the evaluation of lung screening
model.40 Figure 8A,B shows the pictures of normal lung and the car-
cinoma lung, respectively. Zhu et al. developed a deep CNN model
named Deep ConvSurv for survival analysis using pathological im-
ages. Using this Deep ConvSurv model, end-­to-­end survival can be
predicted using pathological images.41
Hussein et al. developed a multiview CNN named Tumour
NetData augmentation for determining nodule of malignant tu-
mours.42 Shen et al. introduced a DL model of multicolumn convo-
lutional neural network (MC-­CNN) to deal with the critical issue of
lung lump malignancy classification. The encouraging results on lump
malignant cells classification reflect the efficiency of MC-­CNN.43,44
Tajbakhsh et al. proposed comparison between two classes of con-
tinuous ML massive training artificial neural networks (MTANNs)
 TANDON et al.

TA B L E 1 Summary of the studies for breast cancer detection and diagnosis using DL models.

Reference Year Objective Image type DL architecture and methods Data set Accuracy
19
Albayrak et al. 2016 Cancer detection Histopathology CNN MITOS ATYPIA-­14 96%
20
Snaphol et al. 2016 Classification Histopathology CNN Alexnet transfer learning BreaKHis 85% to 90%
Albarqouni et al. 22 2016 Mitosis detection Histopathology CNN AggNet MICCAI-­AMIDA-­13 Not defined
23
Kallenberg et al. 2016 Image classification Mammographic CSAE (convolutional sparse autoencoder) Unpublished clinical data set Not defined
Altameem et al. 24 2022 Breast cancer detection Mammographic Fuzzy ensemble Mini-­MIAS +3 99.32%
25
Motlagh et al. 2018 Classification Histopathology CNN ResNet transfer learning Tissue microarray and BreakHis 96.4%
Gecer et al. 26 2018 Classification Whole-­slide breast histopathology CNN and FCN transfer learning NIH Sponsored project Not defined
27
Xie et al. 2019 Clustering Histopathology CNN Inception_V3 and Inception_ResNet_ BreaKHis 76.4% and
V2 transfer learning 59.3%
Le et al. 28 2019 TIL analysis and Whole-­slide tissue images CNN Resnet-­3 4, VGG16 and Inception v4 SEER 89%
Classification transfer learning
(Tumour Infiltrating
Lymphocytes)
Kaur et al. 29 2019 Classification Mammographic CNN and MSVM Mini-­MIAS 95%
30
Toğaçar et al. 2019 Classification Histopathology Autoencoder IDC data set 98.59%
Adem et al.31 2019 Classification Tabled data Autoencoder Kent Ridge-­2 database 91.24%
32
Gandomkar et al. 2018 Classification Histopathology Deep ResNet transfer learning BreaKHis 95.40%,
94.90% and
95.70%
Ekici et al.33 2019 Classification Thermal breast images CNN unpublished 98.95%
Naderan et al.34 2020 Breast cancer detection Histopathology Autoencoder BreaKHis 84.72%
Mohammad 2022 Breast cancer detection Tabled data LR, RF, SVM, VC, DT and a custom CNN Kaggle 99%
Monirujjaman model.
et al.35
Xiaomei Wang 2022 Breast cancer detection BC-­IDC data set CNN and GRU Kaggle 86.21%
et al.36
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8 of 20 | TANDON et al.
(A) (B)
and CNNs. The results show that the performance of MTANNs is
better than CNN with limited training data.45
Jung et al. presented a three-­dimensional deep convolutional
neural network (3D DCNN) having shortcut connections and three
dimensional Deep CNN for lung lump classification. The results
show superior performance metrics using three dimensional deep
46
convolutional networks. Woźniak et al. suggested a novel method
for classifying lung carcinomas. For each pixel of an original picture,
the local variance that gets the result image (‘variance image’) of the
same image size begins with the locating and extraction of the lung
nodule by calculating.47
Mao et al. proposed an unsupervised deep auto encoder for
the classification of lung cancer.48 To ensure a truthful diagnosis of
lung nodules, the proposed framework incorporates the following
two categories of features, (i) appearance features modelled with a
higher-­order Markov Gibbs random field (MGRF) model capable of
describing spatial in homogeneities within the lung nodule and (ii)
geometric features describing the shape geometry of the lung nod-
ules.49 Vaishnavi et al. showed that in CT images, tumour segmenta-
tion and classification are challenging task. So, the authors proposed
a method to automatically detect and classification of lung tumours
tissues.50 Xiea et al. proposed an automatic pulmonary lump detec-
tion using two dimensional CNN for assisting the CT process using
LUNA16 and achieved accuracy of 86.4%.51
Use of CT images for training double convolutional deep neural
network (DCDNN) and a regular convolutional deep neural network
(CDNN) is proposed by Jaki movski et al.52 The ADL model has mul-
tiple strategies for diagnosing malignant nodules efficiently utilized
by Nasrullah et al. In the same, two deep three-­dimensional (3D) cus-
tomized mixed link network (CMixNet) models have been used to
53
detect and classify lung nodules. Silva et al investigated a transfer
learning method based on unsupervised learning achieved by train-
ing a convolutional auto encoder (CAE) with images from the same
54
domain. Ghosal et al proposed the use of a generative adversarial
network (GAN) as a data augmentation strategy for increasing the
55
amount of training data available to CAD systems.
Amjad Rehman, et al. employed support vector machine and K-­
nearest neighbours for the classification of features from CT chest
images.56 Lu, Xinrong et al. proposed an optimal methodology for
F I G U R E 8 (A) Normal lung. (B)
Carcinoma lung right side. Arrow indicates
the malignant mass.
detection of lung carcinoma at early stage. For efficient network ac-
curacy and optimal arrangement Marine predators algorithm is uti-
lized in.57 O. Obulesu et al. proposed a Wilcoxon Signed Generative
Deep Learning (WS-­GDL) method for detection of lung cancer.58
Chan Zhang et al. used masked R-­CNN for image segmentation and
processing of lung nodules.59 Table 2 shows the summary of the
methods used for detection of lung cancer.
3.3 | Brain tumour
Many DL methods have been proposed for diagnosing and detecting
tumours in the brain through CT and MRI. Pereira et al.60 discussed
limitations requiring large amount of time for manual segmentation
of MRI of glioma. Figure 9A,B show the images of normal brain and
brain tumour (high grade glioma), respectively.
A deep neural network to detect brain tumours for customi-
zation of both low and high grade (glioma) pictures in MRI images
is proposed by Havaei et al. 61 Gao et al. introduced the early di-
agnosis of Alzheimer's disease. In the same, authors classified CT
images into three cluster groups that are Alzheimer's disease (AD),
Tumour and normal ageing and implemented advanced CNN archi-
tectures. 62 Ehab et al. selected 44 Glioma images of patients in the
two different categories in image archive data set. 63 Ahmed et al.
presented the study and implementation of DL model to predict
rate of survival of brain tumour patients. Authors have tested their
results on the very small data set due to unavailability of larger
data set. Results show an accuracy of 81.8%. 64,65 A system using
CNN is proposed for early detection of Glioma with approximate
survival rate of 11–15 months and achieved 80% accuracy. 66 Wang
et al. proposed a cascade of CNNs in the MRI section of brain
tumours, and introduced a 2.5D network that offers micro con-
sumption, model complexity and reception fields MRIs. 67 Amin
et al. utilized a high pass filter image to emphasize in homogene-
ities of the MR slices' field effect, which was then fused with the
input slices. 68
Ali et al. proposed an effective approach to use residual networks
for classifying brain tumour types. Accuracy of 99% is achieved by
authors in comparison with earlier work on the same data set.69 Badža
 TANDON et al.

TA B L E 2 Summary of the research papers for lung cancer detection and diagnosis using DL models.

Reference Year Objective Image type Methods Data set Accuracy

41
Zhu et al. 2016 Survival analysis Histopathology CNN NLST 12%
improvement
Hussein et al.43 2017 Lump characterization Volumetric CT CNN LIDC-­IDRI 92.31%
42
Shen et al. 2017 Lung nodule suspiciousness classification Volumetri CT CNN LIDC-­IDRI 87.14%
Wang et al.45 2016 Lung tumour classification CT slices Transfer learning JSRT Not defined
43
Tajbakhshet al. 2017 Lump detection and classification CT slices MTANN and CNN Unpublished Data set 95%
Jung et al.46 2018 Lung tumour classification CT slices 3DCNN transfer learning LUNA-­16 Not defined
47
Wozniak et al. 2018 Small lung nodules detection X-­ray Probabilistic neural network Not defined 92%
Mao et al.48 2018 Lung tumour classification CT scans Autoencoder ELCAP Not defined
49
Shaffie et al. 2018 Lung tumour detection CT scans Autoencoder LIDC-­IDRI 92.20%
50
Vaishnavi et al. 2019 Lung tumour detection CT images Probabilistic neural network Unpublished data set Not defined
Xiea et al. 51 2019 Automated nodule detection CT images 2D CNN transfer learning LUNA-­16 86.42
52
Jakimovski et al. 2019 Lung nodule diagnosis CT images CDNN LONI data set 99.62%
Nasrullah et al. 53 2019 Automatic lung nodule detection Chest X-­ray and CT Recurrent CNN (RCNN) LUNA16 and LIDC-­IDRI 94.17%
images
Silva et al. 54 2020 Lung nodule detection CT images Autoencoder LIDC-­IDRI 0.936 AUC
55
Ghosal et al. 2020 Lung nodule detection and classification CT images Convolutional autoencoder LIDC-­IDRI 95.3%
Rehman, Amjad, et al56 2021 Detection and classification of lung cancer CT Images SVM and KNN VIA ELCAP 93% and 91%
57
Lu, Xinrong et.al 2021 Lung cancer detection CT Images Deep learning RIDER 93.4%
Obulesu, O., et al58 2021 Lung cancer diagnosis CT Images WS-­generative deep learning Unpublished 86%
59
Zhang, Chan, et al 2021 Lung nodule detection CT images CNN Private hospital 93.75%
|
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10 of 20 | TANDON et al.
(A) (B)
et al. presented a novel convolutional neural auto-­encoder for seman-
tic segmentation of brain tumours.70 K. Aswani et al. proposed an
unsupervised dual auto encoder with latent space optimization. The
model is trained using only normal MRI images, which eliminates the
71
need for a massive tumour database. Gupta et al. proposed convo-
lutional neural networks (ConvNet) ensemble for segmenting glioma
72
from magnetic resonance images. Ayesha Younis et al. proposed a
faster convolutional feature maps using CNN using the VGG-­16 archi-
tecture as a primary network. These maps were subsequently catego-
73
rized to produce suggestions for the tumour region. Table 3 shows
the summary of the DL methods for detection of Brain tumours.
3.4 | Cervical cancer
A number of DL methods have also been proposed for the diagnosis
and detection of cervical cancer. Figure 10A,B shows the images of
normal cervix and cervical carcinoma, respectively. Song et al. pro-
posed a segmentation method that could be used to detect and di-
agnose cervical cancer automatically by using super pixel and CNN
method.74 Xu et al. proposed a technique for improving accuracy of
precancerous cells that is cervical dysplasia. The authors have de-
signed a DL framework using multimodal information.75
Devi et al. presented the cervical cancer detection and work-
ing using ANN architecture to classify normal or abnormal cervical
76
cells. A convolutional-­based cervical cancer model for intelligent
and efficient classification implemented by Wu et al.77 Alyafeai et al.
proposed an automated pipeline to detect and classify cervical can-
cer through cervigram images.78 Their pipeline architecture is very
much appropriate for mobile phone deployment with the higher
speed and accuracy of 82%.
Pathania et al. developed a DNA-­focused digital micro holog-
raphy method for HPV screening, with automated methods using
deep-­learning algorithms. The result of this paper shows the excel-
lent sensitivity and specificity (100% concordance) in detecting HPV
79
16 and 18 DNA from cell lines.
Sompawong et al. presented the method for detecting cervical
cancer employing Pap smear histology slides using the Mask Regional
Convolution Neural Network (Mask R-­CNN). This is the first attempt
to use the R-­CNN mask to identify and analyse the cervical cell nu-
80
cleus, screen for normal and aberrant nuclear characteristics.
F I G U R E 9 (A) Normal Brain. (B)
Brain tumour. (arrow indicate high grade
glioma).
Khamparia et al. for training and testing, they used the Herlev data
set, which contains 917 cervical pap smear cells with 26 attributes
and two target variables.81 Chen et al. developed an artificial intelli-
gence (AI) system called CytoBrain to screen abnormal cervical cells
automatically in order to aid in the subjects' subsequent clinical diag-
nosis.82 Chandran et al. developed a model CYENET to automatically
classify cervical cancers based on colposcopy images with an accu-
racy of 73.3%.83 Ensemble approach of machine learning is used for
the diagnosis of cervical cancer automatically.84 Using Boruta analy-
sis and the SVM method, a model for effective feature selection and
prediction for data sets related to cervical cancer was presented to
address this issue.85 Table 4 shows the summary of the work done for
detection of cervical cancer except review and survey articles.
3.5 | Liver cancer
CT and other scans based on DL methods have been proposed
for diagnosis and detection of liver cancer. Figure 11A shows
the normal liver CT scan, Figure 11B shows the Hepato-­cellular
carcinoma and Figure 11C shows the scan of multiple liver
lesions—Metastasis.
Christ et al. presented a technique for liver and lesion segmen-
tation automatically through CT images of abdomen by using the
fully convolutional network model of DL.86 Cohen et al. proposed
a method for detecting small lesions in CT images for liver cancer.
Authors used a combined local and global approach in the system
that can enhance the detection capabilities.87 Das et al. proposed
a technique called watershed Gaussian based DL (WGDL) tech-
nique to find the cancer lesion in CT images of the liver. Authors
have shown an achievement of total classification accuracy around
99.38%.88 Peng et al. proposed a DL model, that is trained and val-
idated the preoperative prediction for the response of patients.89
A new three-­dimensional (3-­D) convolution network (CNN) is pro-
posed by Trivizakis et al.90 Evaluation of the influence of images ac-
quisition on transfer learning (TL) diagnosis by adopting pretrained
neural convolution networks (CNCs) and three phased computed
dynamic contrast tomography (DCE-­C T) is used for primary hepatic
malignancies in.91,92
Budak et al. presented two convolutional deep encoder-­decoder
neural networks (EDCNNs). The networks are constructed and trained
TANDON et al. | 11 of 20

to cascade segments of the liver and lesions in CT images with limited

CNN:96% and VGG: 98.5%

Dice coefficient above 0.8
image quantity.93 Lee et al. investigated liver imaging characteristics

30 times faster result

of stage I–III colorectal cancer (CRC) from 2019, using CNN for the
oncology purposed.94 Dong et al. proposed HFCNN for segmenting
the liver tumour.95 Almotairi et al. presented a DL model for classifying
Not defined

Not defined

Not defined
Accuracy

images and fitting liver segmentation. SegNet deep convolutional en-

80.03%

99.23%
87.62% coder–decoder architecture and accuracy up to 99.9% in the training

99%
81%

95%
phase is shown in.96 Hassan et al. presented a DL based feature rep-
resentation technique with a stacked sparse auto-­encoder. A softmax
285 data set from navy hospital china

layer classifier is used to classify the different important liver diseases

and achieved classification accuracy of 97.2%.97

Nanfang Hospital, Guangzhou

BraTS 2017 and BraTS 2018
Roy et al. presented Histo-­C AE, a multiresolution deep learning
model for segmentation of viable tumours in whole-­slide liver histo-
Cancer imaging archive
BRATS 2013 and 2015

pathology images.98 Also, some of the authors have shown efficient

Nanfang Hospital

results for the cancer detections.99-­101 Table 5 shows the summary

Private data set

BRATS 2018

BRATS 2018
BRATS 2013

Unpublished

of the work done for detection of Liver cancer except review and
BraTS 2015
Database

survey articles.

4 | DISCUSSION
CNN(ResNet) transfer learning
Convolutional autoencoder
Cascaded transfer learning

In this review recent studies related to cancer detection using deep

Stacked autoencoder

learning methods are presented. This article summarizes stud-

CNN and VGG16

ies on cancer diagnostic and prediction using deep learning-­based

2D and 3D CNN

CNN and ANN

Dual encoder

approaches.
Deep CNN
Methods

CNN

CNN
CNN

4.1 | Consistent prediction outcomes based on

deep learning techniques
multimodal MRI
TA B L E 3 Summary of the research papers for brain tumour detection and diagnosis.

CT Images

Deep learning-­based approaches have made major contributions to

the field of cancer research. The research studies cited in the litera-
Type

MRI
MRI

MRI
MRI
MRI

MRI
MRI
MRI
MRI
MRI

ture have primarily concentrated on deep learning approaches. In

the realm of cancer research, deep learning classifiers have largely
Automatic segmentation of tumour

supplanted machine learning models. convolutional neural networks

(CNN) has been the most often utilized deep learning model for can-
Segmentation of brain tumour
Segmentation of brain tumour
Classification of brain tumour

Classification of brain tumour

Classification of brain tumour
Brain tumour segmentation

Brain tumour segmentation

Brain tumour segmentation
Brain tumour classification

cer prediction; roughly 49% of researchers have used CNN to cat-

Brain tumour detection

Brain tumour diagnosis

egorize cancer. Apart from deep learning approaches, the literature

predominantly uses encoders, ensemble learning techniques (Random
Forest Classifier weighted voting, Gradient Boosting Machines) and
support vector machines (SVM). Figure 12 illustrates the distribution
Objective

of articles using machine learning-­based prediction methods.

4.2 | Cancer, type of data and imaging techniques

2022
2020
2021
2021
2016
2017
2017
2017
2017
2019
2019
2019
Year

used for detection

73

The majority of the research publications included in this review con-

Ayesha Younis et al.

centrated on automated cancer detection and prediction. Lung cancer

Aswani et al.71
Ahmed et al.64
60

61

66

68

70
Wang et al.67

is the most widely used cancer, followed by breast cancer. Apart from
Pereira et al.
Havaei et al.

63

Tandel et al.

Amin et al.v

Badža et al.
Gao et al.62
Reference

Ehab et al.

Ali et al.69

lung and breast cancer, the majority of researchers have focused on

the prediction of brain, liver and cervical cancer also. Figure 13 illus-
trates the distribution of research publications by cancer type.
12 of 20 | TANDON et al.

(A) (B)

F I G U R E 1 0 (A) Normal cervix. (B) Cervical carcinoma. (arrow indicating malignant mass).

TA B L E 4 Summary of the research papers for cervical cancer detection and diagnosis using DL models.

DL architecture
Reference Year Objective Image type and methods Data set Accuracy

Song et al.74 2016 Segmentation of cervical cell Histopathology CNN Unpublished 91.83%
cytoplasm
Xu et al.75 2016 Cervical abnormality diagnosis Digital cervicography CNN Unpublished 88.91%
77
Wu1 et al. 2019 Cervical cell classification Cytological images CNN Unpublished 89.28%
78
Alyafeai et al. 2019 Cervix detection and cervical Digital cervicography CNN Intel and mobile 82%
cancer classification ODT data set
Pathania et al.79 2019 Cervical cancer screening Histopathology CNN Unpublished Not defined
Sompawong et al.80 2019 Cervical cancer screening Pap smear histological Mask R-­CNN Thammasat 89.8%
slides transfer University
learning (TU) Hospital
Khamparia et al.81 2020 Cervical cancer classification Pap smear histological Autoencoder Herlev data set 99.2%
slides
Chen et al.82 2021 Automated cervical cell Cervical cell images Autoencoder Unpublished 98.02%
screening
Chandran et al.83 2021 Cervical cancer detection Colposcopic images Autoencoder Intel ODT data 92.3%
set
Umesh Kumar Lilhore 2022 Cervical cancer detection Colposcopic images SVM Tabular data 95%
et al.85

The type of data utilized to train the prediction model has a major
impact on the model's performance. The reliability and accuracy of
the classification model are highly dependent on the data used to
train it. Additionally, mammographic, endoscopic and pathological
images were employed in the literature. The distribution of publi-
cations according to the type of data used to train the prediction
model is highlighted in Figure 14.
researchers for cancer detection. After the study, we found that among all
included papers of this survey most of the authors used a transfer learn-
ing approach. The distribution of publications according to the AI-­based
methods used to train the prediction model is highlighted in Figure 15.
4.4 | Objective for using deep learning in
cancer prediction

4.3 | AI-­based methods for consistent Different objectives like detection, classification and segmentation
prediction outcomes are taken by the researchers to predict the cancer. In this study, most
of the researchers have worked on the detection objective. The dis-
Various deep learning methods like end-­
to-­
end learning and CNN, tribution of publications according to the objective of study used is
transfer learning, auto-­encoders and ensemble learning are used by the highlighted in Figure 16.
TANDON et al. | 13 of 20

(A) (B) (C)

F I G U R E 1 1 (A) Normal liver on CT scan. (B) Hepatocellular carcinoma. (C) Multiple liver lesions—Metastasis (arrows indicating the
malignant lesion).

TA B L E 5 Summary of the research papers for liver cancer detection and diagnosis using DL models.

DL architecture and
Reference Year Objective Image type methods Data set Accuracy
86
Christ et al. 2016 Liver and lesion segmentation CT abdomen FCNN 3DIRCADb data set 93.1%
images
Cohen et al.87 2018 Liver metastases detection CT images FCNN transfer learning Unpublished data set 94.7%
88
Das et al. 2019 Automatic detection of liver cancer CT images DNN Unpublished data set 99.38%
Peng et al.89 2019 DL model for preoperative CT images Residual CNN Unpublished data set 84.3%
prediction
Trivizakiset al.90 2019 Tissue classification in liver MRI 3D CNN Collected from private 83%
tumour hospital
Vanmoreet al.91 2019 Estimation of level of liver damage CT images DCNN transfer learning Not published 98.5%
Budak et al.92 2019 Liver tumour segmentation CT images Deep encoder-­decoder 3DIRCADb Not defined
93
Dong et al. 2020 Liver cancer detection CT images FCNN Not published 97.22%
Almotairi et al.96 2020 Liver tumour segmentation CT liver DNN 3D-­IRCADb-­01 d 99.9%
scans
Hassan et al.97 2020 Diagnosis of focal liver disease Ultrasound FUZZY K MEAN Egyptian Liver 97.2%
images CLUSTERING Research Institute
Roy et al.98 2021 Liver tumour segmentation Whole side CNN auto-­encoder PAIP challenge 2019 95%
image

4.5 | Data set and mode (online and offline) used in
prediction of cancer
The authors have used various types of data sets that are available
both online and offline. In breast cancer most of the authors have used
Break His data set, LIDC_IDRI data set in lung cancer, BraTs data set in
brain cancer, and in liver and cervical cancer most of the authors have
used offline data set or the data set collected from the private hospitals
that are not available publicly. The distribution of publications accord-
ing to the data set and mode is highlighted in Figure 17. The numbers
of commonly available open source data sets for review are used in this
study. Table 6 shows the summary of available open source data sets.
The limitations of this study are as follows:
2. Heterogeneity of studies: FIt can be difficult to directly compare
the performance of different deep learning models due to varia-
tions in the data sets, techniques and evaluation measures across
different research. This might result in potential discrepancies and
make it difficult to draw firm conclusions.
3. Ethical considerations: The ethical implications of depending
exclusively on machine-­driven diagnoses, patient privacy, data
security and other issues are brought up by automated cancer di-
agnosis models. To protect patient confidentiality and autonomy,
these ethical issues must be carefully considered.
5 | FU T U R E S CO PE A N D C H A LLE N G E S

1. Publication bias: Publication bias could have an impact on the There is still potential for evolution to be done with using DL models
evaluation since papers showing promising outcomes are more to find and diagnose cancer cells. After the survey of various papers
likely to be published, which could result in an overestimation related to cancer detection using DL, it is observed that the major chal-
of the usefulness of deep learning models in cancer detection. lenge to train the DL model is the lack of data. Most of the papers
14 of 20 | TANDON et al.

F I G U R E 1 2 Distribution of publication on the basis of Deep learning techniques.

F I G U R E 1 3 Distribution of publication
based on cancer types.

F I G U R E 1 4 Distribution of publication based on the type of images.

TANDON et al.
F I G U R E 1 5 Distribution of publication on the basis deep learning methods.
F I G U R E 1 6 Distribution of publication on the basis of objective.
include confidential information of patients that they had collected
from the hospital and that data are not publicly available. In order
to make those private data available for research purposes, data de-­
identification and data transportation are required. Many of the re-
searchers used the data of the patients from the different hospitals
or the cancer institutions. So it is very difficult to compare the perfor-
mance of the DL models using that data. So, to achieve better accuracy
data samples should be adequate to train, validate and test a DL model.
Some other future challenges in using the DL for medical image
analysis are as follows:
Preparation of High Resolution Data set: For the training of DL
model high resolution data set is required to perform better pre-
diction. Although, the availability of that type of systems to confine
and prepare such a large data set is still a challenge for researchers.
| 15 of 20
Storage of large amounts of high resolution medical images: Even
though continuous improvement in terms of processing power and
memory capacity, availability of compatible hardware resources to
store the high resolution medical images is still a challenge.
Selection of suitable model: Proper selection of suitable model for
capturing needed information from medical images and in terms of
better accuracy.
Selection of Suitable tools and technologies: As medical images
contain hidden information and cancer cells are having very small
size so proper tools are necessary to extract hidden information
from medical images.
Deep transfer learning: The use of deep transfer learning models
is neglected in the literature. Therefore, to enhance the results fur-
ther and to prevent underfitting kind of issues, in near future new
16 of 20 | TANDON et al.

F I G U R E 1 7 Distribution of publication
on the type of data set.

TA B L E 6 Summary of data sets.

Data set Description Dataset source

MITOS ATYPIA-­14 This data set contains the breast cancer biopsy slides scanned by two https://​mitos​-­​atypi​a-­​14.​grand​-­​chall​enge.​org/​
slide scanners: A perio Scan scope XT and Hamamatsu Nano zoomer Datas​et/​
2.0-­HT.
Break-­His This data set contains a breast cancer histopathological image containing https://​web.​inf.​ufpr.​br/​vri/​datab​ases/​breas​
9109 microscopic images of breast using different magnifying factors t-­​c ance​r-­​histo​patho​logic​al-­​datab​ase-­​break​
(40×, 100×, 200× and 400×). his/​
MICCAI-­ This data set contains 500 breast cancer cases from The Cancer Genome http://​tupac.​tue-­​image.​nl/​node/​3
AMIDA-­13 Atlas.
SEER This data set is available in the binary format required by the SEER*Stat https://​seer.​c ancer.​gov/​data/​access.​html
software and in an ASCII text format.
NLST The National Lung Screening Trial (NLST) is a randomized controlled https://​cdas.​c ancer.​gov/​datas​ets/​nlst/​
experiment containing images of chest X-­ray and CT scans.
LIDC-­IDRI This Lung Image Database Consortium image collection (LIDC-­IDRI) https://​wiki.​c ance​rimag​ingar​chive.​net/​displ​ay/​
contains 244,527 Dicom CT images of Lung. Public/​LIDC-­​IDRI#​19413​2fe65​3e4a7​db007​
15f6f​775c012
JSRT The Japanese Society of Radiological Technology (JSRT) contains 154 http://​db.​jsrt.​or.​jp/​eng.​php
nodule and 93 non-­nodule images
BraTS This Brain tumour segmentation (BraTS) data set contains multimodal https://​w ww.​smir.​ch/​BRATS/​​Start​2013
MRI scans that are available as NIfTI files (.nii.gz).
Intel and Mobile This cervical cancer screening data set contains images of cervix https://​w ww.​kaggle.​com/c/​intel​-­​mobil​eodt-­​
ODT for classification of cervical cancer to identify cancerous or cervi​c al-­​c ance​r-­​scree​ning/​data
noncancerous.
BUPA Liver This BUPA liver disorder data set contains blood test results and liver https://​archi​ve.​ics.​uci.​edu/​ml/​datas​ets/​Liver+​
Disorders disorder status of 345 individual male patients. Disor​ders
LiTS This liver tumour segmentation challenge data set contains a training http://​acade​micto​rrents.​com/​detai​ls/​27772​
data set of 130 CT scans and testing data set of 70 CT scans. adef6​f563a​1ecc0​ae19a​528b9​56e6c​8 03ce​

models can be designed by using the deep transfer learning and
deep belief networks.
Hyper-­parameters tuning: Additionally, the hyper-­parameters tun-
ing issue is found to be a challenging issue in the literature, there-
fore, in near future meta-­heuristic techniques such as particle swarm
optimization,99 can be used to tune the initial parameters of the
models automatically.
Image filtering: Filtering models can be used to enhance the vis-
ibility of used images for cancer detection and diagnosis processes.
Some of these filters are as trilateral filter,97 data cleaning, gradient
filter, quantile separated histogram equalization etc.
Multiobjective fitness function: To tune the hyper-­
parameters
of the existing cancer detection and diagnosis approaches vari-
ous multiobjective optimization techniques can be used such as
TANDON et al.
Non-­
dominated sorting genetic algorithm-­
III, parallel strength
Pareto evolutionary algorithm-­II, multiobjective genetic algorithm,
memetic differential evolution, etc.
6 | CO N C LU S I O N
A systematic review of various automated computational deep
learning-­
b ased cancer diagnosis models was presented. Five
types of cancers such as breast, lung, cervical, brain and liver
at an early stage were studied. In total, 686 articles were se-
lected that were published between 2016 and 2022 from five
major databases such as Elsevier, Wiley, IEEE, Springer Nature
and Nature portfolio. Out of these papers, by using systematic
selection criteria, a selection of 113 articles is done for further
reviews. Comparisons were drawn among competitive automated
computational cancer diagnosis models. Various tools that have
been used to build automated computational models were also
discussed. Various shortcomings of the competitive automated
computational cancer diagnosis models were presented. Finally,
a future research direction in the field of automated cancer diag-
nosis models is discussed.
AU T H O R C O N T R I B U T I O N S
Ritu Tandon: Conceptualization (equal); formal analysis (equal); in-
vestigation (equal); methodology (equal); resources (equal); writing
– original draft (equal); writing – review and editing (equal). Shweta
Agrawal: Formal analysis (equal); investigation (equal); project ad-
ministration (equal); supervision (equal); validation (equal). Narendra
Pal Singh Rathore: Conceptualization (equal); data curation (equal);
formal analysis (equal); software (equal); writing – original draft
(equal). Abhinava Mishra: Conceptualization (equal); investigation
(equal); project administration (equal); resources (equal); supervision
(equal); writing – review and editing (equal). SANJIV KUMAR JAIN:
Project administration (equal); supervision (equal); visualization
(equal); writing – original draft (equal); writing – review and editing
(equal).
AC K N O​W L E D
​ G E ​M E N T S
All the CT scan and MRI images are collected from Param MRI
Center, Gwalior, M.P., India.
F U N D I N G I N FO R M AT I O N
‘This research received no external funding’.
C O N FL I C T O F I N T E R E S T S TAT E M E N T
The authors confirm that there are no conflicts of interest.
DATA AVA I L A B I L I T Y S TAT E M E N T
The data that support the findings of this study are available from
the corresponding author upon reasonable request.
| 17 of 20
ORCID
Sanjiv Kumar Jain https://orcid.org/0000-0001-8942-7681
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