Grad-CAM Enhanced Explainable Deep Learning for Multi-Class Lung Cancer Classification Using DE-SAMNet Model

Background/Objectives: Lung cancer (LC) is the leading cause of cancer-related mortality worldwide, making early and accurate diagnosis crucial for improving patient outcomes. Although chest computed tomography (CT) enables detailed assessment of lung abnormalities, manual interpretation is time-consuming, requires expert expertise, and is prone to diagnostic variability. To address these challenges, this study proposes DE-SAMNet, a hybrid deep learning framework for automated multi-class LC classification from CT scans. Methods: The model integrates two pre-trained convolutional neural networks-DenseNet121 and EfficientNetB0-operating in parallel to extract complementary multi-scale features. A Spatial Attention Module (SAM) is applied to each feature stream to emphasize clinically important regions. Final classification is performed through a compact fusion mechanism involving global average pooling, batch normalization, and a fully connected layer. DE-SAMNet was evaluated on two datasets: a public dataset (IQ-OTH/NCCD) with benign, malignant, and normal cases, and a private clinical dataset including benign, malignant, cystic, and healthy cases. Results: On the public dataset, the model achieved a 99.00% F1-score, 98.41% recall, 99.64% precision, and 99.54% accuracy. On the private dataset, it obtained 95.96% accuracy, 95.99% precision, 96.04% F1-score, and 96.21% recall, outperforming existing approaches. To enhance reliability, explainable AI (XAI) techniques such as Grad-CAM were used to visualize the model's decision rationale. The resulting heatmaps effectively highlight lesion-specific regions, offering transparency and supporting clinical interpretability. Conclusions: This explainability strengthens trust in automated predictions and demonstrates the clinical potential of the proposed system. Overall, DE-SAMNet delivers a highly accurate and interpretable solution for early LC detection.