ThyroidEffi 1.0: A Cost-Effective System for High-Performance Multi-Class Thyroid Carcinoma Classification

Background: Automated classification of thyroid Fine Needle Aspiration Biopsy (FNAB) images faces challenges in limited data, inter-observer variability, and computational cost. Efficient, interpretable models are crucial for clinical support. Objective: To develop and externally validate a deep learning system for multi-class thyroid FNAB image classification into three key categories directly guiding post-biopsy treatment in Vietnam: Benign (Bethesda II), Indeterminate/Suspicious (BI, III, IV, V), and Malignant (BVI), achieving high diagnostic accuracy with low computational overhead. Methods: Our pipeline features: (1) YOLOv10 cell cluster detection for informative sub-region extraction/noise reduction; (2) curriculum learning sequencing localized crops to full images for multi-scale capture; (3) adaptive lightweight EfficientNetB0 (4M parameters) balancing performance/efficiency; and (4) a Transformer-inspired module for multi-scale/multi-region analysis. External validation used 1,015 independent FNAB images. Results: ThyroidEffi Basic achieved macro F1 of 89.19% and AUCs of 0.98 (Benign), 0.95 (Indeterminate/Suspicious), 0.96 (Malignant) on the internal test set. External validation yielded AUCs of 0.9495 (Benign), 0.7436 (Indeterminate/Suspicious), 0.8396 (Malignant). ThyroidEffi Premium improved macro F1 to 89.77%. Grad-CAM highlighted key diagnostic regions, confirming interpretability. The system processed 1000 cases in 30 seconds, demonstrating feasibility on widely accessible hardware. Conclusions: This work demonstrates that high-accuracy, interpretable thyroid FNAB image classification is achievable with minimal computational demands.