One of the research gaps in the medical sciences is the study of orphan diseases or rare diseases, due to limited data availability of rare diseases. Our previous study addressed this successfully by developing an Artificial Intelligence (AI)-based medical image classification method using a multilayer fuzzy approach (MFA), for detecting and classifying image abnormalities for large and very small datasets. A fuzzy system is an AI system used to handle imprecise data. There are more than three types of fuzziness in any image data set: 1) due to a projection of a 3D object on a 2D surface, 2) due to the digitalization of the scan, and 3) conversion of the digital image to grayscale, and more. Thus, this was referred to in the previous study as a multilayer fuzzy system, since fuzziness arises from multiple sources. The method used in MFA involves comparing normal images containing abnormalities with the same kind of image without abnormalities, yielding a similarity measure percentage that, when subtracted from a hundred, reveals the abnormality. However, relying on a single standard image in the MFA reduces efficiency, since images vary in contrast, lighting, and patient demographics, impacting similarity percentages. To mitigate this, the current study focused on developing a more robust medical image classification method than MFA, using a many-to-many relation and a multilayer fuzzy approach (MCM) that employs multiple diverse standard images to compare with the abnormal image. For each abnormal image, the average similarity was calculated across multiple normal images, addressing issues encountered with MFA, and enhancing versatility. In this study, an AI-based method of image analysis automation that utilizes fuzzy systems was applied to a cancer data set for the first time. MCM proved to be highly efficient in detecting the abnormality in all types of images and sample sizes and surpassed the gold standard, the convolutional neural network (CNN), in detecting the abnormality in images from a very small data set. Moreover, MCM detects and classifies abnormality without any training, validation, or testing steps for large and small data sets. Hence, MCM may be used to address one of the research gaps in medicine, which detects, quantifies, and classifies images related to rare diseases with small data sets. This has the potential to assist a physician with early detection, diagnosis, monitoring, and treatment planning of several diseases, especially rare diseases.
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