arXiv:2603.15814cs.LGstat.AP2026-03

用历史数据训练模型,推理时仅需当前影像即可预测乳腺癌风险。

Longitudinal Risk Prediction in Mammography with Privileged History Distillation

  • 训练时利用完整历史数据,通过多教师蒸馏提取关键风险信息。
  • 在多期预测中,长周期风险预测性能接近全历史模型,且仅依赖当前影像。
  • 适合临床部署,解决历史数据缺失问题,提升实际应用可行性。

乳腺癌是全球癌症致死的主要原因。基于过往筛查的纵向乳腺癌风险预测模型可提升多年风险预估能力。然而,在真实临床实践中,由于漏检、首次检查、采集时间不一或归档限制,纵向历史数据常不完整、不规则甚至缺失。缺乏既往检查会降低纵向模型性能,限制其应用。尽管训练时有丰富历史数据,但推理时通常无法获取。本文提出一种新方法:在训练中将历史数据作为特权信息,通过特定时间窗口的多教师蒸馏,将纵向风险线索提炼至仅需当前检查的轻量学生模型。每个教师基于完整历史训练,专注于特定预测时域;学生则接收从当前检查重构的历史表示。该方法在包含多年癌症结局的大规模纵向乳腺钼靶数据集CSAW-CC上验证,结果表明:相比无历史基线,本方法显著提升长周期预测的时变AUC,且与全历史模型相当,同时推理仅需当前影像。

原文摘要 · Abstract (English)

Breast cancer remains a leading cause of cancer-related mortality worldwide. Longitudinal mammography risk prediction models improve multi-year breast cancer risk prediction based on prior screening exams. However, in real-world clinical practice, longitudinal histories are often incomplete, irregular, or unavailable due to missed screenings, first-time examinations, heterogeneous acquisition schedules, or archival constraints. The absence of prior exams degrades the performance of longitudinal risk models and limits their practical applicability. While substantial longitudinal history is available during training, prior exams are commonly absent at test time. In this paper, we address missing history at inference time and propose a longitudinal risk prediction method that uses mammography history as privileged information during training and distills its prognostic value into a student model that only requires the current exam at inference time. The key idea is a privileged multi-teacher distillation scheme with horizon-specific teachers: each teacher is trained on the full longitudinal history to specialize in one prediction horizon, while the student receives only a reconstructed history derived from the current exam. This allows the student to inherit horizon-dependent longitudinal risk cues without requiring prior screening exams at deployment. Our new Privileged History Distillation (PHD) method is validated on a large longitudinal mammography dataset with multi-year cancer outcomes, CSAW-CC, comparing full-history and no-history baselines to their distilled counterparts. Using time-dependent AUC across horizons, our privileged history distillation method markedly improves the performance of long-horizon prediction over no-history models and is comparable to that of full-history models, while using only the current exam at inference time.

乳腺癌纵向预测知识蒸馏医疗影像

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