Automated Detection of Malignant Lesions in the Ovary Using Deep Learning Models and XAI

Ovarian lesion classification using transvaginal ultrasound remains challenging due to overlapping imaging characteristics and the dependence on expert interpretation. This study investigates whether lesion-guided region-of-interest (ROI) deep learning can achieve competitive diagnostic performance while reducing the annotation burden associated with pixel-level lesion segmentation. Two publicly available ovarian ultrasound datasets were evaluated: the Multi-Modality Ovarian Tumor Ultrasound (MMOTU) dataset for eight-class classification and the Ovarian Ultrasound Dataset (OUD) for binary classification. Four strategies were compared under a unified framework: global image-based deep learning, lesion-guided ROI-based deep learning, lesion contour-based deep learning, and contour-based radiomics with machine learning classifiers. Four deep learning architectures, MaxViT-Tiny, Swin Transformer, EfficientNet-B7, and ResNet18, were evaluated. Radiomics models were developed using support vector machine, k-nearest neighbors, and artificial neural network classifiers, with ANOVA-based feature selection applied for the lower-sample OUD dataset. The lesion-guided ROI strategy achieved the strongest overall performance, with MaxViT-Tiny obtaining 93.10% accuracy and an AUC of 0.99 on MMOTU and 97.56% accuracy and an AUC of 0.99 on OUD. The contour-based approach achieved comparable accuracy but required substantially higher annotation effort. These findings demonstrate that lesion-guided ROI deep learning provides an effective balance between diagnostic performance and annotation efficiency, offering a practical approach for scalable AI-assisted ovarian ultrasound analysis

Explainable Artificial Intelligence (XAI) has become essential in medical image analysis to ensure transparency of deep learning (DL)-based diagnostic systems. However, selecting appropriate XAI techniques for breast cancer recognition remains largely ad hoc, with limited systematic evaluation across different DL architectures. This study presents a systematic architecture-aware evaluation protocol to assess the effectiveness of nine widely used XAI techniques across four categories of DL models: very deep, lightweight, transformer-based and hybrid neural networks. The evaluation is conducted on a breast ultrasound dataset comprising 780 images using clinically aligned spatial metrics, including Pointing Game, Intersection over Union and Mean Coverage, to quantify agreement between generated explanations and expert-annotated lesion regions. Results indicate that explanation quality is primarily influenced by the interaction between model architecture and XAI method, rather than any single technique consistently outperforming others. Hybrid architectures produce more spatially coherent explanations, while lightweight and transformer-based models exhibit greater variability across methods. The findings show that no single technique generalises across architectures and evaluation criteria, emphasising the need for joint selection of DL models and XAI techniques. Explainability depends on both model design and explanation strategy and should not be considered independently. This work provides a structured evaluation protocol and practical guidance for selecting XAI techniques in breast cancer diagnosis, supporting more transparent clinical decision-support systems. \textcolor{blue}{Code is publicly available at https://github.com/Nishan-Charlie/Explainable-AI}

Ovarian cancer is the most lethal gynecologic malignancy: around 60% of patients are diagnosed at an advanced stage, with an associated 5-year survival rate of about 30%. Early identification of non-responders to neoadjuvant chemotherapy remains a key unmet need, as it could prevent ineffective therapy and avoid delays in optimal surgical management. This work proposes a non-invasive deep learning framework to predict neoadjuvant chemotherapy response from pre-treatment contrast-enhanced CT by leveraging automatically derived 3D lesion masks. The approach encodes axial slices with a partially fine-tuned pretrained image encoder and aggregates slice-level representations into a volumetric embedding through an attention-based module. Training combines classification loss with supervised contrastive regularization and hard-negative mining to improve separation between ambiguous responders and non-responders. The method was developed on a retrospective single-center cohort from the European Institute of Oncology (Milan, IT), including 280 eligible patients (147 responder, 133 non-responder). On the test cohort, the model achieved a ROC-AUC of 0.73 (95% CI: 0.58-0.86) and an F1-score of 0.70 (95% CI: 0.56-0.82). Overall, these results suggest that the proposed architecture learns clinically relevant predictive patterns and provides a robust foundation for an imaging-based stratification tool.