ProtoCAM: Interpretable Few-Shot Mask-Guided Prototypical Learning for Breast Lesion Classification in Ultrasound Imaging

Breast ultrasound imaging plays an important role in the early detection and diagnosis of breast cancer, particularly for patients with dense breast tissue. However, developing reliable deep learning models for ultrasound analysis is challenging due to limited annotated medical data and the need for interpretable predictions. To address these challenges, this paper proposes ProtoCAM, an explainable few-shot learning framework for breast lesion classification that integrates mask-guided feature encoding, prototypical metric learning, and gradient-based visual explanations. The proposed approach leverages lesion masks to guide feature extraction and constructs class prototypes within an embedding space to enable robust classification under limited training samples. The framework was evaluated on the BUSI dataset using a stratified group k-fold cross-validation protocol to prevent patient-level data leakage. Experimental results demonstrate ProtoCAM's high performance in low-data scenarios. In a 3-way 5-shot setting, the proposed method achieves a macro F1-score of 0.910, representing a substantial improvement over standard supervised CNN models. Among the evaluated backbone networks, ResNet18 achieved the best performance, reaching a macro F1-score of 91.65% under a 15-shot configuration, providing interpretable insights into the classification decisions. These results highlight the potential of explainable few-shot learning frameworks for reliable computer-aided breast cancer diagnosis in data-scarce medical imaging environments.