Annotation-efficient Semi-supervised and Active Learning for Breast Cancer Segmentation in DCE-MRI

Accurate breast tumor segmentation in dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is vital for diagnosis and treatment planning. Despite advances in deep learning, its performance remains constrained by the need for extensive voxel-wise annotations. To mitigate this burden, we propose an annotation-efficient framework that jointly optimizes data selection, unlabeled data utilization, and data augmentation under limited annotation budgets. A diversity-aware uncertainty query (DUQ) strategy guides the annotation by jointly modeling data representativeness and informativeness through a representative candidate selector (RCS) and an uncertainty-based decision maker (UDM), ensuring efficient and targeted labeling. To leverage unlabeled data, a cross-decoder consistency regularization (CDCR) mechanism enforces prediction consistency between two decoders with distinct attention mechanisms, enhancing robustness and confidence. Furthermore, a lesion transplant augmentation (LTA) technique synthesizes anatomically valid pseudo samples by transplanting lesion regions from labeled to unlabeled images, effectively expanding training diversity. Experiments were conducted on two DCE-MRI datasets with biopsy-proven breast cancers, one as internal dataset containing 676 subjects and the other as external dataset with 344 subjects. Comparative and ablation results demonstrate that our framework consistently outperforms state-of-the-art semi-supervised and active learning methods, providing a simple yet effective annotation-efficient solution for breast cancer segmentation in DCE-MRI. The code is publicly available at https: //github.com/zouquanling/DUQ_and_CDCR.