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Developing a segmentation cascade deep learning network based on automated prompts.

Yuhe Yao1, Shiran Sun1, Xuena Yan1

  • 1National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Quantitative Imaging in Medicine and Surgery
|March 12, 2026
PubMed
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Accurate auto-segmentation of nasopharyngeal carcinoma gross tumor volume (GTVnx) is improved by a novel two-stage deep learning framework. This cascaded approach enhances precision and efficiency for GTVnx segmentation in clinical settings.

Area of Science:

  • Medical Imaging
  • Artificial Intelligence
  • Oncology

Background:

  • Accurate auto-segmentation of nasopharyngeal carcinoma gross tumor volume (GTVnx) presents a significant clinical challenge.
  • Existing single-stage deep learning models often face limitations in precision for GTVnx segmentation.

Purpose of the Study:

  • To introduce a novel two-stage deep learning cascade framework for enhanced GTVnx auto-segmentation.
  • To improve the accuracy and computational efficiency of GTVnx segmentation compared to single-stage models.

Main Methods:

  • Developed an end-to-end model with a localization prompt generation unit (PGU) and a fine segmentation unit (FSU), linked by an attention mechanism.
  • Evaluated three PGU strategies (prompt-mask, prompt-box, dual-prompt) on 276 nasopharyngeal carcinoma (NPC) patient datasets.
Keywords:
Auto-segmentationpromptstwo-stage

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  • Assessed performance using Dice similarity coefficient (DSC), 95% Hausdorff distance (HD95), and mean distance to agreement (MDA), with statistical analysis via paired t-tests.
  • Main Results:

    • The dual-prompt strategy significantly outperformed the baseline single-stage model, increasing DSC by 9.7% (0.8219 vs. 0.7489, P<0.001).
    • HD95 decreased by 28.2% (9.22 vs. 12.84 mm, P<0.001) and MDA improved by 31.4% (1.53 vs. 2.23 mm, P<0.001) with the dual-prompt approach.
    • Qualitative analysis confirmed superior anatomical fidelity and statistically significant improvements over single-prompt variants (P<0.01).

    Conclusions:

    • The proposed two-stage deep learning-based auto-segmentation (DLAS) framework offers a computationally efficient solution for GTVnx segmentation.
    • This approach significantly enhances the accuracy and reliability of GTVnx segmentation, featuring a lightweight architecture and high scalability.
    • The framework represents a promising pathway for clinical integration in radiation oncology for nasopharyngeal carcinoma treatment planning.