A multimodal explainable ai framework to assist in the differential diagnosis of head and neck reactive follicular hyperplasia and follicular lymphoma: an international multicentre study
Year: 2026
Type: article
Abstract: The differential diagnosis between reactive follicular hyperplasia (RFH) and follicular lymphoma (FL) in head and neck tissues represents a diagnostic challenge, particularly given the rarity of extranodal FL at these anatomical sites. We developed and evaluated an explainable multimodal artificial intelligence framework to assist in this differential diagnosis. This international multicentre study assembled 108 cases (54 RFH, 54 FL) from 10 centres across 4 continents, representing one of the largest collections of head and neck follicular lesions. We developed a multimodal framework integrating convolutional neural networks (CNNs: AlexNet, VGG16, ResNet18), vision transformers (CellViT + +), graph neural networks (Cell-GNN for spatial analysis), and gradient-boosted decision trees (XGBoost) with morphometric features. Explainability was achieved through Grad-CAM visualisation and SHAP analysis. The best-performing model (CellViT + +) achieved 95.7% accuracy on the internal test set. External validation demonstrated accuracy of 80.5% (ResNet18, Cohort 1) and 69.0% (VGG16-Seg, Cohort 2), with performance variation reflecting the challenge of generalisation across centres. Explainability analysis revealed that the multimodal framework integrated morphometric features (nuclear area, eccentricity) with epidemiological context (patient age, consistent with known FL demographics). Cell-GNN spatial analysis identified significant architectural reorganisation in FL, quantified by Hedges' g = -6.65, representing the loss of normal follicular polarity. This study demonstrates the feasibility of a multimodal explainable AI framework for assisting in the differential diagnosis of rare head and neck follicular lesions. The integration of morphological, spatial, and clinical features provides a foundation for future collaborative validation studies and potential diagnostic support in specialised pathology settings.
Authors: Lucas Lacerda de Souza, Zhiyang Chen, Cinthia Veronica Bardález López de Cáceres, Nathalia Gomes Rodrigues, Hélder Antônio Rebelo Pontes, Ciro Dantas Soares, Fábio Luiz Coracin, Igor Kimura, Sheila Aparecida Coelho Siqueira, Fernanda Viviane Mariano, Talita de Carvalho Kimura, João Felipe Leite Bonfitto, Leandro Luiz Lopes de Freitas, Sibele Nascimento de Aquino, Paul Hankinson, Hanya Mahmood, Hannah Walsh, Itzia Araceli Torres Torres, Adalberto Mosqueda-Taylor, Pedro Bandeira Aleixo, Manoela Domingues Martins, Carolina Louzada Menna-Barreto, Ahmed Hagag, Thaís Cerqueira Reis Nakamura, Giovanna Calabrese dos Santos, Matheus Cardoso Moraes, Marcio Ajudarte Lopes, Alan Roger Santos-Silva, Felipe Paiva Fonseca, Syed Ali Khurram, Pablo Agustin Vargas
Institutions: Universidade Estadual de Campinas (UNICAMP), University of Sheffield, Universidade Federal de Minas Gerais, Universidade Federal do Pará, Hospital de Câncer de Barretos, Universidade de São Paulo, Universidade Federal de Juiz de Fora, Universidad Autónoma Metropolitana, Santa Casa Hospital, Universidade Federal do Rio Grande do Sul, Benha University, Arab Open University, Arab Open University, Arab Open University, Universidade Federal de São Paulo
Language: English
Topic: AI in cancer detection
Subfield: Artificial Intelligence
Field: Computer Science
Domain: Physical Sciences
Open Access status: hybrid
Estimated APC paid: $4,790
OpenAlex ID: W7159888709