Multiple Instance Learning for Glioma Diagnosis using Hematoxylin and Eosin Whole Slide Images: An Indian cohort Study

Brain tumors represent a severe and life-threatening condition, demanding precise diagnosis and tailored treatment strategies. This study advances patient care with findings from rigorous multiple-instance-learning experimentations across various feature extractors and aggregators in brain tumor histopathology. It establishes new performance benchmarks in glioma subtype classification across multiple datasets, including a novel dataset focused on the Indian demographic (IPD-Brain), providing a valuable resource for existing research. Using a ResNet-50, pretrained on histopathology datasets, for feature extraction, combined with DTFD feature aggregator, our approach achieves state-of-the-art AUCs of 88.08 on IPD-Brain and 95.81 on TCGA-Brain dataset respectively for three-way glioma subtype classification. Moreover, it establishes new benchmarks in grading and detecting IHC molecular biomarkers (IDH1 (mutant R132H), TP53, ATRX, Ki-67) through H&E stained whole slide images for the IPD-Brain dataset. The work also highlights a significant correlation between the model decision-making processes and the diagnostic reasoning of pathologists, underscoring its capability to mimic professional diagnostic procedures.