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Network visualization and pyramidal feature comparison for ablative treatability classification using digitized cervix imagesUterine cervical cancer is a leading cause of women’s mortality worldwide. Cervical tissue ablation is an effective surgical excision of high grade lesions that are determined to be precancerous. Our prior work on the Automated Visual Examination (AVE) method demonstrated a highly effective technique to analyze digital images of the cervix for identifying precancer. Next step would be to determine if she is treatable using ablation. However, not all women are eligible for the therapy due to cervical characteristics. We present a machine learning algorithm that uses a deep learning object detection architecture to determine if a cervix is eligible for ablative treatment based on visual characteristics presented in the image. The algorithm builds on the well-known RetinaNet architecture to derive a simpler and novel architecture in which the last convolutional layer is constructed by upsampling and concatenating specific RetinaNet pretrained layers, followed by an output module consisting of a Global Average Pooling (GAP) layer and a fully connected layer. To explain the recommendation of the deep learning algorithm and determine if it is consistent with lesion presentation on the cervical anatomy, we visualize classification results using two techniques: our (i) Class-selective Relevance Map (CRM), which has been reported earlier, and (ii) Class Activation Map (CAM). The class prediction heatmaps are evaluated by a gynecologic oncologist with more than 20 years of experience. Based on our observation and the expert’s opinion, the customized architecture not only outperforms the baseline RetinaNet network in treatability classification, but also provides insights about the features and regions considered significant by the network toward explaining reasons for treatment recommendation. Furthermore, by investigating the heatmaps on Gaussian-blurred images that serve as surrogates for out-of-focus cervical pictures we demonstrate the effect of image quality degradation on cervical treatability classification and underscoring the need for using images with good visual quality. © 2021 by the authors. Licensee MDPI, Basel, Switzerland.