Multiple instance learning (MIL) is a weakly supervised learning paradigm that is becoming increasingly popular because it requires less labeling effort than fully supervised methods. This is especially interesting for areas where the creation of large annotated datasets remains challenging, as in medicine. Although recent deep learning MIL approaches have obtained state-of-the-art results, they are fully deterministic and do not provide uncertainty estimations for the predictions. In this work, we introduce the attention Gaussian process (AGP) model, a novel probabilistic attention mechanism based on Gaussian processes (GPs) for deep MIL. AGP provides accurate bag-level predictions as well as instance-level explainability and can be trained end-to-end. Moreover, its probabilistic nature guarantees robustness to overfit on small datasets and uncertainty estimations for the predictions. The latter is especially important in medical applications, where decisions have a direct impact on the patient's health. The proposed model is validated experimentally as follows. First, its behavior is illustrated in two synthetic MIL experiments based on the well-known MNIST and CIFAR-10 datasets, respectively. Then, it is evaluated in three different real-world cancer detection experiments. AGP outperforms state-of-the-art MIL approaches, including deterministic deep learning ones. It shows a strong performance even on a small dataset with less than 100 labels and generalizes better than competing methods on an external test set. Moreover, we experimentally show that predictive uncertainty correlates with the risk of wrong predictions, and therefore it is a good indicator of reliability in practice. Our code is publicly available.

Medical image segmentation is a challenging task, particularly due to inter- and intra-observer variability, even between medical experts. In this paper, we propose a novel model, called Probabilistic Inter-Observer and iNtra-Observer variation NetwOrk (Pionono). It captures the labeling behavior of each rater with a multidimensional probability distribution and integrates this information with the feature maps of the image to produce probabilistic segmentation predictions. The model is optimized by variational inference and can be trained end-to-end. It outperforms state-of-the-art models such as STAPLE, Probabilistic U-Net, and models based on confusion matrices. Additionally, Pionono predicts multiple coherent segmentation maps that mimic the rater’s expert opinion, which provides additional valuable information for the diagnostic process. Experiments on real-world cancer segmentation datasets demonstrate the high accuracy and efficiency of Pionono, making it a powerful tool for medical image analysis.