# RACR-MIL: Rank-aware contextual reasoning for weakly supervised grading of squamous cell carcinoma using whole slide images

arXiv: https://arxiv.org/abs/2308.15618 · HTML: https://mlsanity.com/paper/2308.15618/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 14 of its 45 references that are in the map.
- First posted on arXiv 29 Aug 2023.

## Builds on (most cited first, 14 of 14)

- [Emerging Properties in Self-Supervised Vision Transformers](https://mlsanity.com/paper/2104.14294/) (2021)
- [Class-Balanced Loss Based on Effective Number of Samples](https://mlsanity.com/paper/1901.05555/) (2019)
- [Attention-based Deep Multiple Instance Learning](https://mlsanity.com/paper/1802.04712/) (2018)
- [Heterogeneous Graph Transformer](https://mlsanity.com/paper/2003.01332/) (2020)
- [TransMIL: Transformer based Correlated Multiple Instance Learning for Whole Slide Image Classification](https://mlsanity.com/paper/2106.00908/) (2021)
- [Dual-stream Multiple Instance Learning Network for Whole Slide Image Classification with Self-supervised Contrastive Learning](https://mlsanity.com/paper/2011.08939/) (2020)
- [Nystr"omformer: A Nystr"om-Based Algorithm for Approximating Self-Attention](https://mlsanity.com/paper/2102.03902/) (2021)
- [Diffusion Improves Graph Learning](https://mlsanity.com/paper/1911.05485/) (2019)
- [DeeperGCN: All You Need to Train Deeper GCNs](https://mlsanity.com/paper/2006.07739/) (2020)
- [Whole Slide Images are 2D Point Clouds: Context-Aware Survival Prediction using Patch-based Graph Convolutional Networks](https://mlsanity.com/paper/2107.13048/) (2021)
- [Nested Hierarchical Transformer: Towards Accurate, Data-Efficient and Interpretable Visual Understanding](https://mlsanity.com/paper/2105.12723/) (2021)
- [Accounting for Dependencies in Deep Learning Based Multiple Instance Learning for Whole Slide Imaging](https://mlsanity.com/paper/2111.01556/) (2021)
- [Self-learning for weakly supervised Gleason grading of local patterns](https://mlsanity.com/paper/2105.10420/) (2021)
- [Weakly-Supervised Deep Learning Model for Prostate Cancer Diagnosis and Gleason Grading of Histopathology Images](https://mlsanity.com/paper/2212.12844/) (2022)

## Abstract (arXiv)

Squamous cell carcinoma (SCC) is one of the most common cancer subtype, with an increasing incidence and a significant impact on cancer-related mortality. SCC grading using whole slide images is inherently challenging due to the lack of a standardized grading protocol and substantial tissue heterogeneity. We propose RACR-MIL, a weakly-supervised SCC grading approach that achieves robust generalization across multiple anatomies (skin, head & neck, lung). RACR-MIL is an attention-based multiple-instance learning framework that introduces two key innovations for learning grade-specific contextual representations: (1) a hybrid WSI graph that captures both local tissue context and non-local phenotypic dependencies between tumor regions, and (2) rank-ordering constraints on the attention mechanism that encourage consistent prioritization of higher-grade tumor regions and improve region-level grade confidence, aligning with pathologist's diagnostic process. Our model achieves state-of-the-art performance across multiple SCC datasets, achieving 3-9% improvements over existing methods and up to 10% improvement in tumor localization. In a pilot study, pathologists reported that RACR-MIL improved grading efficiency in 60% of cases, underscoring its potential as a clinically viable cancer diagnosis and grading assistant.