Neighborhood attention transformer multiple instance learning for whole slide image classification.

Introduction: Pathologists rely on whole slide images (WSIs) to diagnose cancer by identifying tumor cells and subtypes. Deep learning models, particularly weakly supervised ones, classify WSIs using image tiles but may overlook false positives and negatives due to the heterogeneous nature of tumors. Both cancerous and healthy cells can proliferate in patterns that extend beyond individual tiles, leading to errors at the tile level that result in inaccurate tumor-level classifications. Methods: To address this limitation, we introduce NATMIL (Neighborhood Attention Transformer Multiple Instance Learning), which utilizes the Neighborhood Attention Transformer to incorporate contextual dependencies among WSI tiles. NATMIL enhances multiple instance learning by integrating a broader tissue context into the model. Our approach enhances the accuracy of tumor classification by considering the broader tissue context, thus reducing errors associated with isolated tile analysis. Results: We conducted a quantitative analysis to evaluate NATMIL's performance against other weakly supervised algorithms. When applied to subtyping non-small cell lung cancer (NSCLC) and lymph node (LN) tumors, NATMIL demonstrated superior accuracy. Specifically, NATMIL achieved accuracy values of 89.6% on the Camelyon dataset and 88.1% on the TCGA-LUSC dataset, outperforming existing methods. These results underscore NATMIL's potential as a robust tool for improving the precision of cancer diagnosis using WSIs. Discussion: Our findings demonstrate that NATMIL significantly improves tumor classification accuracy by reducing errors associated with isolated tile analysis. The integration of contextual dependencies enhances the precision of cancer diagnosis using WSIs, highlighting NATMILs´ potential as a robust tool in pathology.