A novel rotation and scale-invariant deep learning framework leveraging conical transformers for precise differentiation between meningioma and solitary fibrous tumor

Meningiomas, the most prevalent tumors of the central nervous system, can have overlapping histopathological features with solitary fibrous tumors (SFT), presenting a significant diagnostic challenge. Accurate differentiation between these two diagnoses is crucial for optimal medical management. Currently, immunohistochemistry and molecular techniques are the methods of choice for distinguishing between them; however, these techniques are expensive and not universally available. In this article, we propose a rotational and scale-invariant deep learning framework to enable accurate discrimination between these two tumor types. The proposed framework employs a novel architecture of conical transformers to capture both global and local imaging markers from whole-slide images, accommodating variations across different magnification scales. A weighted majority voting schema is utilized to combine individual scale decisions, ultimately producing a complementary and more accurate diagnostic outcome. A dataset comprising 92 patients (46 with meningioma and 46 with SFT) was used for evaluation. The experimental results demonstrate robust performance across different validation methods. In train-test evaluation, the model achieved 92.27% accuracy, 87.77% sensitivity, 97.55% specificity, and 92.46% F1-score. Performance further improved in 4-fold cross-validation, achieving 94.68% accuracy, 96.05% sensitivity, 93.11% specificity, and 95.07% F1-score. These findings highlight the potential of AI-based diagnostic approaches for precise differentiation between meningioma and SFT, paving the way for innovative diagnostic tools in pathology.