Systematic Evaluation of Vision Transformers for Automated Cervical Cancer Classification: Optimization, Statistical Validation, and Clinical Interpretability

Accurate cervical cytology image classification is a key component of automated cervical cancer screening, where reliable recognition of normal, precancerous, and cancer-associated cellular patterns from Pap smear images can improve screening efficiency and diagnostic consistency. However, this task remains challenging because cervical cells exhibit complex morphology, subtle intra-class variations, and strong inter-class similarities. Existing convolution-based models capture local texture well but have limited ability to model long-range relationships, whereas attention-based models provide broader context but often lack explicit structural guidance. To address these limitations, we propose a geometry-aware classification framework for cervical cancer screening-oriented cytology image analysis, incorporating semantic abstraction and structural priors learned from pre-trained vision-language features. The method uses Gaussian expert modules to generate axis-wise priors from global semantic information, capturing structural regularities such as nuclear alignment and cellular spatial organization. These priors are embedded into an axial self-attention module to modulate similarity computation along horizontal and vertical directions, improving long-range dependency modeling and structure-sensitive feature interaction. Experiments on the Mendeley liquid-based cytology and SIPaKMeD datasets show that the proposed method achieves 99.48% accuracy on the former and 96.08% on the latter, with balanced gains in recall, precision, and overall classification performance. Visual analysis further shows that the learned priors highlight diagnostically relevant cellular regions, demonstrating the potential of the proposed framework as a screening-oriented decision-support tool for cervical cytology.

Vision Transformers $(\texttt{ViT})$ have become the architecture of choice for many computer vision tasks, yet their performance in computer-aided diagnostics remains limited. Focusing on breast cancer detection from mammograms, we identify two main causes for this shortfall. First, medical images are high-resolution with small abnormalities, leading to an excessive number of tokens and making it difficult for the softmax-based attention to localize and attend to relevant regions. Second, medical image classification is inherently fine-grained, with low inter-class and high intra-class variability, where standard cross-entropy training is insufficient. To overcome these challenges, we propose a framework with three key components: (1) Region of interest $(\texttt{RoI})$ based token reduction using an object detection model to guide attention; (2) contrastive learning between selected $\texttt{RoI}$ to enhance fine-grained discrimination through hard-negative based training; and (3) a $\texttt{DINOv2}$ pretrained $\texttt{ViT}$ that captures localization-aware, fine-grained features instead of global $\texttt{CLIP}$ representations. Experiments on public mammography datasets demonstrate that our method achieves superior performance over existing baselines, establishing its effectiveness and potential clinical utility for large-scale breast cancer screening. Our code is available for reproducibility here: https://aih-iitd.github.io/publications/attend-what-matters

Over the years, Convolutional Neural Networks (CNNs) have demonstrated strong capability in cancer detection and classification using medical images. However, CNN-based models often struggle to capture long-range contextual dependencies. In such scenarios, integrating Compact Convolutional Transformer (CCT) architectures after the CCT layer allows CNN-extracted features to reshape into compact patch tokens using a CCT tokenizer, followed by the addition of positional embeddings to preserve spatial structure. Using 5-fold cross-validation, the model was tested on 3 sets of breast cancer mammography. With only 250,435 parameters, the model achieved 99%-100% accuracy across 3 datasets, indicating robust generalization. Explainable AI (XAI) was integrated into the model to explain the breast cancer classification process to enhance clinical trust. The results indicate that the proposed framework is suitable for computer-aided diagnosis systems, particularly in resource-constrained clinical environments. The novelty of the proposed CNN-integrated CCT overcomes the limitation of CNN's gradient degradation in the last layers by integrating convolutional tokenization with transformer-based learning. Lighter than ViT, which is effective in capturing long-range dependencies, the model has also proven efficient in breast cancer classification by capturing long-range dependencies among breast tissue regions.