Abstract

Abstract

Abstract
Deep learning has been extensively applied to medical imaging tasks over the past years, achieving outstanding results. However, the obscure reasoning of the models and the lack of supportive evidence causes both clinicians and patients to distrust the models' predictions, hindering their adoption in clinical practice. In recent years, the research community has focused on developing explanations capable of revealing a model's reasoning. Among various types of explanations, example-based explanations emerged as particularly intuitive for medical practitioners. Despite the intuitiveness and wide development of example-based explanations, no work provides a comprehensive review of existing example-based explainability works in the medical image domain. In this work, we review works that provide example-based explanations for medical imaging tasks, reflecting on their strengths and limitations. We identify the absence of objective evaluation metrics, the lack of clinical validation and privacy concerns as the main issues that hinder the deployment of example-based explanations in clinical practice. Finally, we reflect on future directions contributing towards the deployment of example-based explainability in clinical practice.

Abstract
Breast cancer patients often face difficulties when choosing among diverse surgeries. To aid patients, this paper proposes ACID-GAN (Anatomically and Clinically Informed Deep Generative Adversarial Network), a conditional generative model for predicting post-operative breast cancer outcomes using deep learning. Built on Pix2Pix, the model incorporates clinical metadata, such as surgery type and cancer laterality, by introducing a dedicated encoder for semantic supervision. Further improvements include colour preservation and anatomically informed losses, as well as clinical supervision via segmentation and classification modules. Experiments on a private dataset demonstrate that the model produces realistic, context-aware predictions. The results demonstrate that the model presents a meaningful trade-off between generating precise, anatomically defined results and maintaining patient-specific appearance, such as skin tone and shape. © 2025 Elsevier B.V., All rights reserved.

Abstract
Breast cancer locoregional treatment includes a wide variety of procedures with diverse aesthetic outcomes. The aesthetic assessment of such procedures is typically subjective, hindering the fair comparison between their outcomes, and consequently restricting evidence-based improvements. Most objective evaluation tools were developed for conservative surgery, focusing on asymmetries while ignoring other relevant traits. To overcome these limitations, we propose SiameseOrdinalCLIP, an ordinal classification network based on image-text matching and pairwise ranking optimisation for the aesthetic evaluation of breast cancer treatment. Furthermore, we integrate a concept bottleneck module into the network for increased explainability. Experiments on a private dataset show that the proposed model surpasses the state-of-the-art aesthetic evaluation and ordinal classification networks. © 2025 Elsevier B.V., All rights reserved.