A Trust-Centered Explainable Deep-Learning Framework for Acute Lymphoblastic Leukemia Detection Using Multi-Model Fusion and Interpretability Scoring

Currently, advances in healthcare technologies are transforming medical diagnostics, particularly for data-driven disease detection. Acute lymphoblastic leukemia is a common and life-threatening blood cancer, especially prevalent in children. Although existing artificial intelligence-based diagnostic models have demonstrated promising accuracy, their black-box nature limits transparency, explainability, and clinical trust. Moreover, most explainable artificial intelligence approaches for leukemia diagnosis rely primarily on qualitative visual explanations and lack a unified quantitative mechanism to measure trust. This study presents a novel, trust-centered explainable deep-learning framework for automated acute lymphoblastic leukemia detection using 153 publicly available microscopic blood smear images and multiple transfer-learning models. Among the evaluated architectures, the fine-tuned EfficientNetB4 achieved high diagnostic performance, attaining an accuracy of 98.31%, and was selected as the base model of the proposed framework. Beyond diagnostic accuracy, this work introduces a novel unified interpretability score that quantitatively assesses model trustworthiness by integrating diagnostic performance, explanation robustness (evaluated using deletion and stability metrics), and clinician trust feedback into a single reliability measure. This quantitative trust formulation represents a distinct advancement over existing studies based on explainable artificial intelligence, which typically rely on isolated or qualitative explainability assessments. The framework further enhances transparency through visual and textual explanations generated using standard post hoc explainable methods and advanced fusion heatmaps, while human-centric evaluation is conducted using two clinician-based trust scales. Overall, this study provides a unified and transparent framework that jointly evaluates accuracy, explainability, and clinician trust, representing a step towards the clinical adoption of trustworthy artificial intelligence driven leukemia diagnostic systems.