# A Gradient Mapping Guided Explainable Deep Neural Network for Extracapsular Extension Identification in 3D Head and Neck Cancer Computed Tomography Images

arXiv: https://arxiv.org/abs/2201.00895 · HTML: https://mlsanity.com/paper/2201.00895/

## Key facts

- Cited by 2 papers in the map (data through 14 Oct 2026).
- Builds on 21 of its 42 references that are in the map.
- First posted on arXiv 3 Jan 2022.

## Builds on (most cited first, 21 of 21)

- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [Very Deep Convolutional Networks for Large-Scale Image Recognition](https://mlsanity.com/paper/1409.1556/) (2014)
- [Grad-CAM: Visual Explanations from Deep Networks via Gradient-based Localization](https://mlsanity.com/paper/1610.02391/) (2016)
- [Densely Connected Convolutional Networks](https://mlsanity.com/paper/1608.06993/) (2016)
- [Axiomatic Attribution for Deep Networks](https://mlsanity.com/paper/1703.01365/) (2017)
- [Learning Deep Features for Discriminative Localization](https://mlsanity.com/paper/1512.04150/) (2015)
- [Deep Inside Convolutional Networks: Visualising Image Classification Models and Saliency Maps](https://mlsanity.com/paper/1312.6034/) (2013)
- [Visualizing and Understanding Convolutional Networks](https://mlsanity.com/paper/1311.2901/) (2013)
- [Learning Important Features Through Propagating Activation Differences](https://mlsanity.com/paper/1704.02685/) (2017)
- [Spatial Transformer Networks](https://mlsanity.com/paper/1506.02025/) (2015)
- [SmoothGrad: removing noise by adding noise](https://mlsanity.com/paper/1706.03825/) (2017)
- [Striving for Simplicity: The All Convolutional Net](https://mlsanity.com/paper/1412.6806/) (2014)
- [The (Un)reliability of saliency methods](https://mlsanity.com/paper/1711.00867/) (2017)
- [Not Just a Black Box: Learning Important Features Through Propagating Activation Differences](https://mlsanity.com/paper/1605.01713/) (2016)
- [Explainable Artificial Intelligence: Understanding, Visualizing and Interpreting Deep Learning Models](https://mlsanity.com/paper/1708.08296/) (2017)
- [Patch-based Convolutional Neural Network for Whole Slide Tissue Image Classification](https://mlsanity.com/paper/1504.07947/) (2015)
- [Explainable deep learning models in medical image analysis](https://mlsanity.com/paper/2005.13799/) (2020)
- [Robust Explainability: A Tutorial on Gradient-Based Attribution Methods for Deep Neural Networks](https://mlsanity.com/paper/2107.11400/) (2021)
- [Liver lesion segmentation informed by joint liver segmentation](https://mlsanity.com/paper/1707.07734/) (2017)
- [Uniformizing Techniques to Process CT scans with 3D CNNs for Tuberculosis Prediction](https://mlsanity.com/paper/2007.13224/) (2020)
- [Detecting Scatteredly-Distributed, Small, andCritically Important Objects in 3D OncologyImaging via Decision Stratification](https://mlsanity.com/paper/2005.13705/) (2020)

## Built on by (most cited first, 2 of 2)

- [Analysis of the Two-Step Heterogeneous Transfer Learning for Laryngeal Blood Vessel Classification: Issue and Improvement](https://mlsanity.com/paper/2402.19001/) (2024)
- [Selecting Interpretability Techniques for Healthcare Machine Learning models](https://mlsanity.com/paper/2406.10213/) (2024)

## Abstract (arXiv)

Diagnosis and treatment management for head and neck squamous cell carcinoma (HNSCC) is guided by routine diagnostic head and neck computed tomography (CT) scans to identify tumor and lymph node features. Extracapsular extension (ECE) is a strong predictor of patients' survival outcomes with HNSCC. It is essential to detect the occurrence of ECE as it changes staging and management for the patients. Current clinical ECE detection relies on visual identification and pathologic confirmation conducted by radiologists. Machine learning (ML)-based ECE diagnosis has shown high potential in the recent years. However, manual annotation of lymph node region is a required data preprocessing step in most of the current ML-based ECE diagnosis studies. In addition, this manual annotation process is time-consuming, labor-intensive, and error-prone. Therefore, in this paper, we propose a Gradient Mapping Guided Explainable Network (GMGENet) framework to perform ECE identification automatically without requiring annotated lymph node region information. The gradient-weighted class activation mapping (Grad-CAM) technique is proposed to guide the deep learning algorithm to focus on the regions that are highly related to ECE. Informative volumes of interest (VOIs) are extracted without labeled lymph node region information. In evaluation, the proposed method is well-trained and tested using cross validation, achieving test accuracy and AUC of 90.2% and 91.1%, respectively. The presence or absence of ECE has been analyzed and correlated with gold standard histopathological findings.