Toward Clinically Dependable AI for Brain Tumors: A Unified Diagnostic–Prognostic Framework and Triadic Evaluation Model

Abstract

Artificial intelligence (AI) has shown promising performance in brain tumor diagnosis and prognosis; however, most reported advances remain difficult to translate into clinical practice due to limited interpretability, inconsistent evaluation protocols, and weak generalization across datasets and institutions. In this work, we present a critical synthesis of recent brain tumor AI studies (2020–2025) guided by two novel conceptual tools: a unified diagnostic-prognostic framework and a triadic evaluation model emphasizing interpretability, computational efficiency, and generalizability as core dimensions of clinical readiness. Following PRISMA 2020 guidelines, we screened and analyzed over 100 peer-reviewed studies. A structured analysis of reported metrics reveals systematic trends and trade-offs—for instance, between model accuracy and inference latency—rather than providing a direct performance benchmark. This synthesis exposes critical gaps in current evaluation practices, particularly the under-reporting of interpretability validation, deployment-level efficiency, and external generalization. By integrating conceptual structuring with evidence-driven analysis, this work provides a framework for more clinically grounded development and evaluation of AI systems in neuro-oncology.