Hierarchical Deep Decision Tree-Based Network for Odontogenic Cystic Lesion Classification in CBCT Images

Odontogenic cystic lesions (OCLs) are complex jaw abnormalities that require a precise diagnosis of the disease for treatment. Visual OCL diagnosis is commonly based on reviewing cone-beam computed tomography (CBCT) to identify morpho-pathological features associated with specific lesion types in a hierarchical manner. Current state-of-the-art methods focus on extracting features from the image without any guidance beyond the lesion diagnosis, and do not fully leverage the hierarchical relationship between the lesion diagnosis and morphological features. In this study, we propose a hierarchical deep decision tree network (H2DT-Net) with three modules: a deep decision tree-based hierarchical learning module (DHLM) to leverage inter-categorical relationships; a feature category embedding module (FCEM) to capture representations from both diagnostic and morpho-pathological domains and support the DHLM; and a lesion localised attention module (LLAM) to facilitate the feature extraction process by generating lesion-focused attention maps. Evaluated on 289 CBCT images, H2DT-Net achieved state-of-the-art performance in OCL classification. We further demonstrate that our method is effective in clinical settings, where it outperformed six maxillofacial clinicians in diagnostic assessment.