Deep learning models for microsatellite instability screening in low-resource settings

Background: Microsatellite stability status determination is important for prognostication and therapeutic decision making in colorectal cancer management, but the conventional methods for this assessment are not readily available, especially in low- and middle-income countries. Deep learning (DL) models have been proposed for addressing this problem; however, potential computational cost due to model complexity and inadequate explainability may limit their adoption in low-resource settings. This study explored the potential of explainable lightweight models for detection of microsatellite instability in colorectal cancer. Methods: DL models were trained using a public dataset of colorectal cancer histology images and then used to classify a set of test images into one of two classes: microsatellite instability or microsatellite stability. The models were compared for efficiency. Gradient-weighted class activation mapping (Grad-CAM) was used to interpret the models' decision making. Results: The simpler convolutional neural network (CNN) trained from scratch had modest performance (accuracy=0.757, area under receiver-operating characteristic curve [AUROC]=0.840). With an attention mechanism added, these values increased, but specificity and sensitivity reduced. Pretrained models performed better than the ones trained from scratch, and EfficientNet_B0 had the best balance of high performance and low computational requirements (accuracy=0.936, AUROC=0.990, negative predictive value=0.923, specificity=0.953, 4,010,000 trainable parameters, 0.38 gigaFLOPs). However, a simple CNN model with attention mechanism had the best interpretability based on Grad-CAM. Conclusion: This study demonstrated that DL models that are lightweight when compared to previously proposed ones can be useful for colorectal cancer microsatellite instability screening in resource-limited settings while balancing performance and computational efficiency.