PubMed1995
Machine learning procedures, in unsupervised and supervised manner, can enable their users to achieve knowledge hardly comprehensible by even the best experts. This is true also if the clinical knowledge has been carefully assembled in a prospective way. A data set including 165 patients with elevated routine laboratory tests was extensively studied according to clinical history, laboratory profile and liver biopsy. Unsupervised learning by Kohonen feature map disclosed 4 groups of patients: the largest one with no or slight histopathological changes (116) and three smaller, more homogenous, with more diseased patients. Standardized histopathological scorings of the liver specimens defined patients into two groups. Fifty-eight of them were, according to the analysis, recommended for a liver biopsy, due to more severe degrees of inflammation and fibrosis. One-hundred and seven of the patients, in whom liver biopsy was retrospectively considered unnecessary, had only minor degrees of inflammation, fibrosis and/or steatosis. Supervised learning, using the inductive systems based on Quinlan's ID3 and CART algorithms, extracted knowledge in the form of decision trees. This approach could define a need for biopsy either with a very few significant findings or by pathways containing quotients and multiplications of the different basic items. These procedures were analyzed and compared for their theoretical and applicative performances. The cluster and Fischerian discriminant analyses were performed in order to compare the classification performance. The medical appropriateness of the obtained results is satisfying, therefore decision support systems, outlined in this study, should be evaluated in wider clinical practice. To achieve this goal, an example of a Medical Logical Module (MLM), based on the Arden Syntax, is given.