Towards Accurate and Interpretable Neuroblastoma Diagnosis via Contrastive Multi-scale Pathological Image Analysis

Neuroblastoma, adrenal-derived, is among the most common pediatric solid malignancies, characterized by significant clinical heterogeneity. Timely and accurate pathological diagnosis from hematoxylin and eosin-stained whole-slide images is critical for patient prognosis. However, current diagnostic practices primarily rely on subjective manual examination by pathologists, leading to inconsistent accuracy. Existing automated whole-slide image classification methods encounter challenges such as poor interpretability, limited feature extraction capabilities, and high computational costs, restricting their practical clinical deployment. To overcome these limitations, we propose CMSwinKAN, a contrastive-learning-based multi-scale feature fusion model tailored for pathological image classification, which enhances the Swin Transformer architecture by integrating a Kernel Activation Network within its multilayer perceptron and classification head modules, significantly improving both interpretability and accuracy. By fusing multi-scale features and leveraging contrastive learning strategies, CMSwinKAN mimics clinicians' comprehensive approach, effectively capturing global and local tissue characteristics. Additionally, we introduce a heuristic soft voting mechanism guided by clinical insights to bridge patch-level predictions to whole-slide image-level classifications seamlessly. We verified the CMSwinKAN on the publicly available BreakHis dataset and the PpNTs dataset, which was established by our hospital. Results demonstrate that CMSwinKAN performs better than existing state-of-the-art pathology-specific models pre-trained on large datasets. Our source code is available at https://github.com/JSLiam94/CMSwinKAN.