Explainable Multimodal AI Approach to Reduce Unnecessary Breast Biopsies

Recently, there has been rise in multimodal vision-language models for computer-aided diagnosis (CAD), yet their application in breast diagnosis, particularly for predicting biopsy outcomes remains limited. This study presents a multimodal vision-language approach, incorporating Grad-CAM as an Explainable AI (XAI) technique, to predict benign tumors in patients recommended for biopsy, especially those classified as BI-RADS 4 and 5. A novel multimodal framework was devel- oped using Vision Transformer (ViT) for imaging feature extraction and DeBERTa-V3-Large for textual embeddings. The model was trained and evaluated on a comprehensive in-house dataset comprising 1,632 patients, each with four mammography views and a corresponding radiology report. The features of both modalities were extracted independently and fused by late fusion before classification. Grad-CAM was used to generate visual explanations highlighting key regions influencing model predictions. The proposed model demonstrated high sensitivity 90%, 95%, 99%, and 100% with corresponding specificities of 40%, 36%, 18%, and 11%, respectively. The best AUC achieved was 0.72 by multimodal approach on the test set, outperforming the image only (0.66) and text-only (0.68) baselines. The proposed multimodal architecture, enhanced with Grad-CAM, demonstrates a strong potential to identify benign tumors among high-risk patients, offering interpretable insights and thereby helping reduce unnecessary biopsies, patient anxiety, and healthcare costs.