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Reject Option for Medical Image Classification Using CNN-Derived Latent-Space Neighbourhood Analysis.

September 21, 2026pubmed logopapers

Authors

Arcangeli A,De Santi LA,Santarelli MF,Celi S,Positano V

Affiliations (4)

  • Bioengineering Unit, Fondazione Toscana G. Monasterio, Via Giuseppe Moruzzi, 1, Pisa, 56124, Italy.
  • Institute of Clinical Physiology - CNR, Via Giuseppe Moruzzi, 1, Pisa, 56124, Italy.
  • Bioengineering Unit, Fondazione Toscana G. Monasterio, via Aurelia Sud 309, Massa, 54100, Italy.
  • Bioengineering Unit, Fondazione Toscana G. Monasterio, Via Giuseppe Moruzzi, 1, Pisa, 56124, Italy. [email protected].

Abstract

Reliable uncertainty estimation is a key requirement for the clinical adoption of convolutional neural networks (CNNs) in biomedical imaging. We propose a reject option framework that assesses prediction reliability by leveraging the local structure of the latent space. The method is based on three latent-space features: Simple Data Point Target Density ( <math xmlns="http://www.w3.org/1998/Math/MathML"> <msub><mrow><mi>DPTD</mi></mrow> <mrow><mi>S</mi></mrow> </msub> </math> ), defined as the proportion of a sample's nearest neighbours sharing its label, a distance-weighted extension ( <math xmlns="http://www.w3.org/1998/Math/MathML"> <msub><mrow><mi>DPTD</mi></mrow> <mrow><mi>W</mi></mrow> </msub> </math> ), and the <math xmlns="http://www.w3.org/1998/Math/MathML"> <mmultiscripts><mrow><mi>k</mi></mrow> <mrow></mrow> <mrow><mrow></mrow> <mo>∗</mo></mrow> </mmultiscripts> </math> value. These metrics characterise local label agreement and intra-class consistency without relying on explicit parametric assumptions. A logistic regression rejector is trained post hoc using features derived from the latent representations of the base CNN. Experiments were conducted on two public neuroimaging datasets: ADNI (FDG-PET for Alzheimer's disease) and PPMI (DaTSCAN SPECT for Parkinson's disease). Using all three latent-space features, the rejector achieved AUC-ROC values of 0.843 (95% CI: 0.809-0.874) on ADNI and 0.884 (95% CI: 0.867-0.900) on PPMI, with corresponding eAURC values of 0.0278 (95% CI: 0.0193-0.0370) and 0.0169 (95% CI: 0.0133-0.0209), respectively. For the full-feature configuration, no significant difference from maximum softmax probability (MSP) was detected on ADNI for either AUC-ROC or eAURC, whereas MSP performed significantly better on PPMI for both metrics. The proposed framework provides a representation-based mechanism to assess prediction reliability through local latent-space structure. As a post-hoc approach, it can be integrated into existing CNN pipelines without modifying the underlying model, offering a practical tool for uncertainty-aware decision support in biomedical imaging.

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