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Peer-Reviewed Publication
Med Image Anal2026;113104148.June 3, 2026Journal Article

Beyond attention heatmaps: How to get better explanations for multiple instance learning models in histopathology.

Mina Jamshidi Idaji1, Julius Hense2, Tom Neuhäuser2, Augustin Krause3, Yanqing Luo3, Oliver Eberle2, Thomas Schnake2, Laure Ciernik2, Farnoush Rezaei Jafari2, Reza Vahidimajd4, Jonas Dippel5, Christoph Walz6, Frederick Klauschen7, Andreas Mock8, Klaus-Robert Müller9
1Berlin Institute for the Foundations of Learning and Data, Berlin, Germany; Machine Learning Group, Technische Universität Berlin, Berlin, Germany. Electronic address: mina.jamshidi.idaji@tu-berlin.de.
2Berlin Institute for the Foundations of Learning and Data, Berlin, Germany; Machine Learning Group, Technische Universität Berlin, Berlin, Germany.
3Machine Learning Group, Technische Universität Berlin, Berlin, Germany.
4Department of Computer Science and Engineering, The Chinese University of Hong Kong, Hong Kong.
5Berlin Institute for the Foundations of Learning and Data, Berlin, Germany; Machine Learning Group, Technische Universität Berlin, Berlin, Germany; Aignostics, Berlin, Germany.
6Institute of Pathology, Ludwig Maximilian University, Munich, Germany.
7Institute of Pathology, Ludwig Maximilian University, Munich, Germany; German Cancer Research Center, Heidelberg, and German Cancer Consortium, Munich, Germany; Institute of Pathology, Charité Universitätsmedizin, Berlin, Germany.
8Institute of Pathology, Ludwig Maximilian University, Munich, Germany; German Cancer Research Center, Heidelberg, and German Cancer Consortium, Munich, Germany.
9Berlin Institute for the Foundations of Learning and Data, Berlin, Germany; Machine Learning Group, Technische Universität Berlin, Berlin, Germany; Department of Artificial Intelligence, Korea University, Seoul, Republic of Korea; Max-Planck Institute for Informatics, Saarbrücken, Germany.

Abstract

Multiple instance learning (MIL) has enabled substantial progress in computational histopathology, where a large amount of patches from gigapixel whole slide images are aggregated into slide-level predictions. Heatmaps are widely used to validate MIL models and to discover tissue biomarkers. Yet, the validity of these heatmaps has barely been investigated. In this work, we introduce a general fram…

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