Novel Pipeline for Diagnosing Acute Lymphoblastic Leukemia Sensitive to Related Biomarkers

Acute Lymphoblastic Leukemia (ALL) is one of the most common types of childhood blood cancer. The quick start of the treatment process is critical to saving the patient's life, and for this reason, early diagnosis of this disease is essential. Examining the blood smear images of these patients is one of the methods used by expert doctors to diagnose this disease. Deep learning-based methods have numerous applications in medical fields, as they have significantly advanced in recent years. ALL diagnosis is not an exception in this field, and several machine learning-based methods for this problem have been proposed. In previous methods, high diagnostic accuracy was reported, but our work showed that this alone is not sufficient, as it can lead to models taking shortcuts and not making meaningful decisions. This issue arises due to the small size of medical training datasets. To address this, we constrained our model to follow a pipeline inspired by experts' work. We also demonstrated that, since a judgement based on only one image is insufficient, redefining the problem as a multiple-instance learning problem is necessary for achieving a practical result. Our model is the first to provide a solution to this problem in a multiple-instance learning setup. We introduced a novel pipeline for diagnosing ALL that approximates the process used by hematologists, is sensitive to disease biomarkers, and achieves an accuracy of 96.15%, an F1-score of 94.24%, a sensitivity of 97.56%, and a specificity of 90.91% on ALL IDB 1. Our method was further evaluated on an out-of-distribution dataset, which posed a challenging test and had acceptable performance. Notably, our model was trained on a relatively small dataset, highlighting the potential for our approach to be applied to other medical datasets with limited data availability.