Histopathology in focus: a review on explainable multi-modal approaches for breast cancer diagnosis

Precision and timeliness in breast cancer detection are paramount for improving patient outcomes. Traditional diagnostic methods have predominantly relied on unimodal approaches, but recent advancements in medical data analytics have enabled the integration of diverse data sources beyond conventional imaging techniques. This review critically examines the transformative potential of integrating histopathology images with genomic data, clinical records, and patient histories to enhance diagnostic accuracy and comprehensiveness in multi-modal diagnostic techniques. It explores early, intermediate, and late fusion methods, as well as advanced deep multimodal fusion techniques, including encoder-decoder architectures, attention-based mechanisms, and graph neural networks. An overview of recent advancements in multimodal tasks such as Visual Question Answering (VQA), report generation, semantic segmentation, and cross-modal retrieval is provided, highlighting the utilization of generative AI and visual language models. Additionally, the review delves into the role of Explainable Artificial Intelligence (XAI) in elucidating the decision-making processes of sophisticated diagnostic algorithms, emphasizing the critical need for transparency and interpretability. By showcasing the importance of explainability, we demonstrate how XAI methods, including Grad-CAM, SHAP, LIME, trainable attention, and image captioning, enhance diagnostic precision, strengthen clinician confidence, and foster patient engagement. The review also discusses the latest XAI developments, such as X-VARs, LeGrad, LangXAI, LVLM-Interpret, and ex-ILP, to demonstrate their potential utility in multimodal breast cancer detection, while identifying key research gaps and proposing future directions for advancing the field.