Prediction of Metastasis in Paragangliomas and Pheochromocytomas Using Machine Learning Models: Explainability Challenges.

One of the main issues with paragangliomas and pheochromocytomas is that these tumors have up to a 20% rate of metastatic disease, which cannot be reliably predicted. While machine learning models hold great promise for enhancing predictive accuracy, their often opaque nature limits trust and adoption in critical fields such as healthcare. Understanding the factors driving predictions is essential not only for validating their reliability but also for enabling their integration into clinical decision-making. In this paper, we propose an architecture that combines data mining, machine learning, and explainability techniques to improve predictions of metastatic disease in these types of cancer and enhance trust in the models. A wide variety of algorithms have been applied for the development of predictive models, with a focus on interpreting their outputs to support clinical insights. Our methodology involves a comprehensive preprocessing phase to prepare the data, followed by the application of classification algorithms. Explainability techniques were integrated to provide insights into the key factors driving predictions. Additionally, a feature selection process was performed to identify the most influential variables and explore how their inclusion affects model performance. The best-performing algorithm, Random Forest, achieved an accuracy of 96.3%, precision of 96.5%, and AUC of 0.963, among other metrics, combining strong predictive capability with explainability that fosters trust in clinical applications.