SAP-ViT: A Self-Attributing Patch Vision Transformer for Medical Image Classification

Vision Transformer (ViT) classifiers commonly rely on a global classification (CLS) token for image-level prediction, which is poorly aligned with local interpretability requirements in medical imaging. We propose SAP-ViT, a Self-Attributing Patch Vision Transformer that replaces CLS-based classification with direct aggregation of last-layer patch embeddings. This design makes class predictions decomposable into patch-level contributions as part of the forward pass. To encourage concise and readable evidence, SAP-ViT applies sparsity regularization to the patch-weight distribution. Since self-attention mixes information across patch tokens, we further introduce an input-space back-mapping mechanism to estimate which input patches contribute to influential output patch embeddings. We evaluate SAP-ViT qualitatively and quantitatively on multiple medical image classification datasets spanning different imaging modalities. The results show that SAP-ViT maintains strong classification performance while providing consistent and interpretable patch-level explanations across datasets. Ablation results further show that both sparsity regularization and the alignment component of input-space back-mapping contribute to the final explanation quality. Overall, SAP-ViT provides a favorable trade-off between predictive accuracy and interpretability for ViT-based medical image classification.