# Explanation Stability of Test-Time Adaptation in Computational Pathology: A Large-Scale Benchmark

arXiv: https://arxiv.org/abs/2608.07062 · HTML: https://mlsanity.com/paper/2608.07062/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 29 of its 37 references that are in the map.
- First posted on arXiv 7 Aug 2026.

## Builds on (most cited first, 29 of 29)

- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [An Image is Worth 16x16 Words: Transformers for Image Recognition at Scale](https://mlsanity.com/paper/2010.11929/) (2020)
- [Swin Transformer: Hierarchical Vision Transformer using Shifted Windows](https://mlsanity.com/paper/2103.14030/) (2021)
- [Grad-CAM: Visual Explanations from Deep Networks via Gradient-based Localization](https://mlsanity.com/paper/1610.02391/) (2016)
- [EfficientNet: Rethinking Model Scaling for Convolutional Neural Networks](https://mlsanity.com/paper/1905.11946/) (2019)
- [On Calibration of Modern Neural Networks](https://mlsanity.com/paper/1706.04599/) (2017)
- [Axiomatic Attribution for Deep Networks](https://mlsanity.com/paper/1703.01365/) (2017)
- [WILDS: A Benchmark of in-the-Wild Distribution Shifts](https://mlsanity.com/paper/2012.07421/) (2020)
- [Sanity Checks for Saliency Maps](https://mlsanity.com/paper/1810.03292/) (2018)
- [Grad-CAM++: Improved Visual Explanations for Deep Convolutional Networks](https://mlsanity.com/paper/1710.11063/) (2017)
- [RISE: Randomized Input Sampling for Explanation of Black-box Models](https://mlsanity.com/paper/1806.07421/) (2018)
- [Quantifying Attention Flow in Transformers](https://mlsanity.com/paper/2005.00928/) (2020)
- [Score-CAM: Score-Weighted Visual Explanations for Convolutional Neural Networks](https://mlsanity.com/paper/1910.01279/) (2019)
- [Continual Test-Time Domain Adaptation](https://mlsanity.com/paper/2203.13591/) (2022)
- [Efficient Test-Time Model Adaptation without Forgetting](https://mlsanity.com/paper/2204.02610/) (2022)
- [Improving robustness against common corruptions by covariate shift adaptation](https://mlsanity.com/paper/2006.16971/) (2020)
- [Rotation Equivariant CNNs for Digital Pathology](https://mlsanity.com/paper/1806.03962/) (2018)
- [Towards Stable Test-Time Adaptation in Dynamic Wild World](https://mlsanity.com/paper/2302.12400/) (2023)
- [A Comprehensive Survey on Test-Time Adaptation under Distribution Shifts](https://mlsanity.com/paper/2303.15361/) (2023)
- [Parameter-free Online Test-time Adaptation](https://mlsanity.com/paper/2201.05718/) (2022)
- [Robust Test-Time Adaptation in Dynamic Scenarios](https://mlsanity.com/paper/2303.13899/) (2023)
- [Entropy is not Enough for Test-Time Adaptation: From the Perspective of Disentangled Factors](https://mlsanity.com/paper/2403.07366/) (2024)
- [Universal Test-time Adaptation through Weight Ensembling, Diversity Weighting, and Prior Correction](https://mlsanity.com/paper/2306.00650/) (2023)
- [SoTTA: Robust Test-Time Adaptation on Noisy Data Streams](https://mlsanity.com/paper/2310.10074/) (2023)
- [ViDA: Homeostatic Visual Domain Adapter for Continual Test Time Adaptation](https://mlsanity.com/paper/2306.04344/) (2023)
- [COME: Test-time adaption by Conservatively Minimizing Entropy](https://mlsanity.com/paper/2410.10894/) (2024)
- [Ranked Entropy Minimization for Continual Test-Time Adaptation](https://mlsanity.com/paper/2505.16441/) (2025)
- [Towards Reliable Test-Time Adaptation: Style Invariance as a Correctness Likelihood](https://mlsanity.com/paper/2512.07390/) (2025)
- [Reliability-Gated Source Anchoring for Continual Test-Time Adaptation](https://mlsanity.com/paper/2605.14063/) (2026)

## Abstract (arXiv)

Test-time adaptation (TTA) has become a practical way to adapt deployed models to unlabeled target data, a setting that is especially relevant in computational pathology where staining, scanner, and cohort shifts are routine. While most TTA methods are evaluated by their effect on accuracy, clinical use also depends on whether the model's explanations remain reliable after adaptation. In this paper, we take a closer look at this largely unmeasured effect. We study explanation stability under TTA across two histopathology benchmarks, Camelyon17 and NCT CRC-HE, using five architectures ranging from convolutional networks to vision transformers and a pathology foundation model, seventeen TTA methods, and four attribution families. Across 2,958 adaptation runs, we observe a clear and systematic pattern: TTA methods differ sharply in how much they move model explanations, with frozen-backbone methods leaving attributions almost unchanged and continual methods such as CoTTA and RoTTA causing the largest drift. This effect is not uniform. Convolutional networks are substantially more sensitive than transformer and foundation-model backbones, and explanation drift increases with adaptation strength while remaining largely insensitive to batch size. Surprisingly, explanation stability is only weakly coupled to adaptation quality. Some methods preserve explanations almost perfectly while degrading calibration or accuracy, producing silent failures that would be missed by accuracy-only or explanation-only evaluation. These findings show that explanation stability is a distinct reliability axis for TTA in computational pathology. We release the metric, protocol, and full benchmark to support future work on adaptation methods that are not only accurate, but also stable and clinically auditable. Code: https://github.com/bahumanyarg11/tta-explanation-stability-pipeline