RACR-MIL: Rank-aware contextual reasoning for weakly supervised grading of squamous cell carcinoma using whole slide images

arXiv:2308.15618 · cs.CV, cs.LG · Submitted 2023-08-29 · Read on arXiv

cs.CV, cs.LG

Submitted: 2023-08-29

Updated: 2026-08-24

Comments: Accepted to Medical Image Analysis

License: http://creativecommons.org/licenses/by/4.0/

The gist: Squamous cell carcinoma (SCC) is one of the most common cancer subtype, with an increasing incidence and a significant impact on cancer-related mortality.

Terminology

Abstract

Squamous cell carcinoma (SCC) is one of the most common cancer subtype, with an increasing incidence and a significant impact on cancer-related mortality. SCC grading using whole slide images is inherently challenging due to the lack of a standardized grading protocol and substantial tissue heterogeneity. We propose RACR-MIL, a weakly-supervised SCC grading approach that achieves robust generalization across multiple anatomies (skin, head & neck, lung). RACR-MIL is an attention-based multiple-instance learning framework that introduces two key innovations for learning grade-specific contextual representations: (1) a hybrid WSI graph that captures both local tissue context and non-local phenotypic dependencies between tumor regions, and (2) rank-ordering constraints on the attention mechanism that encourage consistent prioritization of higher-grade tumor regions and improve region-level grade confidence, aligning with pathologist's diagnostic process. Our model achieves state-of-the-art performance across multiple SCC datasets, achieving 3-9% improvements over existing methods and up to 10% improvement in tumor localization. In a pilot study, pathologists reported that RACR-MIL improved grading efficiency in 60% of cases, underscoring its potential as a clinically viable cancer diagnosis and grading assistant.

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