An image extraction device, an image extraction system, an image extraction method, and an image extraction program are capable of extracting an appropriate reference image from a database by using a pathological image as a query. The image extraction device includes: an acquisition unit which acquires a pathological image; a first calculation unit which calculates a local feature amount of the pathological image; a second calculation unit which calculates a non-local feature amount based on a correlation with the local feature amount; a third calculation unit which calculates a degree of similarity between the non-local feature amount and a feature amount of each of a plurality of reference images stored in a database; and an extraction unit which extracts one or more reference images based on the degree of similarity.