# Implementing Trust in Non-Small Cell Lung Cancer Diagnosis with a Conformalized Uncertainty-Aware AI Framework in Whole-Slide Images

## TL;DR

This paper introduces TRUECAM, an AI framework that improves trust in non-small cell lung cancer diagnosis by addressing model and data uncertainties in whole-slide images.

## Contribution

TRUECAM is a novel AI framework that combines uncertainty-aware methods and conformal prediction to enhance trustworthiness in cancer diagnostics.

## Key findings

- TRUECAM improves classification accuracy and robustness in non-small cell lung cancer subtyping.
- The framework enhances interpretability and data efficiency while maintaining controlled error rates.
- TRUECAM achieves fairness improvements and is effective across diverse AI model architectures.

## Abstract

Ensuring trustworthiness is fundamental to the development of artificial intelligence (AI) that is considered societally responsible, particularly in cancer diagnostics, where a misdiagnosis can have dire consequences. Current digital pathology AI models lack systematic solutions to address trustworthiness concerns arising from model limitations and data discrepancies between model deployment and development environments. To address this issue, we developed TRUECAM, a framework designed to ensure both data and model trustworthiness in non-small cell lung cancer subtyping with whole-slide images. TRUECAM integrates 1) a spectral-normalized neural Gaussian process for identifying out-of-scope inputs and 2) an ambiguity-guided elimination of tiles to filter out highly ambiguous regions, addressing data trustworthiness, as well as 3) conformal prediction to ensure controlled error rates. We systematically evaluated the framework across multiple large-scale cancer datasets, leveraging both task-specific and foundation models, illustrate that an AI model wrapped with TRUECAM significantly outperforms models that lack such guidance, in terms of classification accuracy, robustness, interpretability, and data efficiency, while also achieving improvements in fairness. These findings highlight TRUECAM as a versatile wrapper framework for digital pathology AI models with diverse architectural designs, promoting their responsible and effective applications in real-world settings.