Abstract
Saliency maps are widely used to explain deep learning predictions in medical imaging, yet visually plausible explanations do not necessarily reflect a model’s true decision process and may therefore mislead clinicians. We investigate this problem using a Vision Transformer-based breast MRI classifier trained on the ODELIA Breast MRI Challenge dataset and evaluate multiple saliency methods, including Last-layer Attention, Attention Rollout, Grad-SAM, Gradient Attention Rollout, GMAR, Grad-CAM, and HiResCAM. Our study highlights two often-overlooked challenges in perturbation-based faithfulness evaluation. First, method rankings depend strongly on the perturbation strategy, varying across intensity-based perturbations and transformer-based attention masking. Second, benchmarking saliency methods requires distinguishing between class-specific and class-agnostic explanations. To enable fair comparisons, we introduce non-class-specific variants of gradient-based methods and evaluate both settings separately. Across protocols, Grad-CAM and Gradient Attention Rollout consistently emerged as the strongest class-specific methods, although their relative ranking depended on the evaluation design. These findings expose important limitations of current saliency-based explainability approaches and highlight the need for more robust and standardized evaluation frameworks for trustworthy clinical AI systems.
Links to Paper and Supplementary Materials
Main Paper (Open Access Version): https://papers.miccai.org/miccai-2026-sat/paper/iMIMIC_013.pdf
SharedIt Link: Not yet available
SpringerLink (DOI): Not yet available
Supplementary Material: Not Submitted
Link to Open Review
Open Review Page: Not Available
BibTex
@InProceedings{PooPea_Faithful_MICCAISAT2026,
author = { Poolpol, Peachapong AND Detjen, Henrik H. J. AND Petersen, Eike},
title = { { Faithful Faithfulness Evaluations: Challenges & Pitfalls Learned from a Breast MRI Case Study } },
booktitle = {Medical Image Computing and Computer Assisted Intervention -- MICCAI 2026 Workshops and Challenges},
year = {2026},
publisher = {Springer Nature Switzerland},
volume = {LNCS 17279},
month = {pending},
page = {pending}
}