# How Close Are We? Limitations and Progress of AI Models in Banff Lesion Scoring

arXiv: https://arxiv.org/abs/2510.27158 · HTML: https://mlsanity.com/paper/2510.27158/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 7 of its 12 references that are in the map.
- First posted on arXiv 31 Oct 2025.

## Builds on (most cited first, 7 of 7)

- [U-Net: Convolutional Networks for Biomedical Image Segmentation](https://mlsanity.com/paper/1505.04597/) (2015)
- [Mask R-CNN](https://mlsanity.com/paper/1703.06870/) (2017)
- [EfficientNet: Rethinking Model Scaling for Convolutional Neural Networks](https://mlsanity.com/paper/1905.11946/) (2019)
- [Omni-Seg: A Scale-aware Dynamic Network for Renal Pathological Image Segmentation](https://mlsanity.com/paper/2206.13632/) (2022)
- [Glo-In-One-v2: Holistic Identification of Glomerular Cells, Tissues, and Lesions in Human and Mouse Histopathology](https://mlsanity.com/paper/2411.16961/) (2024)
- [Feature-prompting GBMSeg: One-Shot Reference Guided Training-Free Prompt Engineering for Glomerular Basement Membrane Segmentation](https://mlsanity.com/paper/2406.16271/) (2024)
- [IRS: Incremental Relationship-guided Segmentation for Digital Pathology](https://mlsanity.com/paper/2505.22855/) (2025)

## Abstract (arXiv)

The Banff Classification provides the global standard for evaluating renal transplant biopsies, yet its semi-quantitative nature, complex criteria, and inter-observer variability present significant challenges for computational replication. In this study, we explore the feasibility of approximating Banff lesion scores using existing deep learning models through a modular, rule-based framework. We decompose each Banff indicator - such as glomerulitis (g), peritubular capillaritis (ptc), and intimal arteritis (v) - into its constituent structural and inflammatory components, and assess whether current segmentation and detection tools can support their computation. Model outputs are mapped to Banff scores using heuristic rules aligned with expert guidelines, and evaluated against expert-annotated ground truths. Our findings highlight both partial successes and critical failure modes, including structural omission, hallucination, and detection ambiguity. Even when final scores match expert annotations, inconsistencies in intermediate representations often undermine interpretability. These results reveal the limitations of current AI pipelines in replicating computational expert-level grading, and emphasize the importance of modular evaluation and computational Banff grading standard in guiding future model development for transplant pathology.