Clinical-Oriented Hierarchical Machine Learning Framework for Early Kidney Tumor Detection and Malignant Subtype...

Objectives: Kidneytumors, particularly renal cell carcinoma (RCC), represent a critical public health concern due to their prevalence and the severe consequences of late diagnosis. Traditional diagnostic techniques, though widely used, are often limited by human error, inter-observer variability, and delayed recognition of malignant subtypes, underscoring the urgent need for automated, accurate, and reproducible solutions. Methods: To address these challenges, this study introduces a hierarchical, AI-driven framework for early detection and precise classification of kidney tumors from CT scans. At its core, the framework uses a specialized encoder, RAD-DINO-MAIRA-2, to extract highly discriminative imaging features, which are subsequently processed through multiple machine learning classifiers tailored to distinct hierarchical levels of diagnosis. Results: Using benchmark kidney tumor datasets, the framework was rigorously validated across 25 independent trials. Performance was assessed using accuracy, reproducibility, and robustness metrics, with results revealing a maximum accuracy of 98.29% and a mean accuracy of 94.72%. Notably, the Gaussian Process classifier achieved perfect performance in tumor type classification, while the MLP classifier attained flawless results in malignant subtype differentiation. Comparative analyses demonstrate that our hierarchical approach outperforms conventional DL-based pipelines by reducing sensitivity to dataset variability and providing a clinically viable path for integration into diagnostic workflows. Combining state-of-the-art feature extraction with hierarchical classification, the proposed framework delivers a robust and interpretable tool with substantial promise for improving patient outcomes in real-world clinical practice.