MLPTR-CC: Multi-label Pathology Test Recommendation using Classifier Chains and SHAP

Abstract

Diagnostic decision making often relies on a sequence of pathology tests that bridge patient symptoms and final disease diagnosis. Existing clinical decision-support systems typically focus on predicting single diseases and do not explicitly recommend sets of intermediate tests or model dependencies among them. In this paper, we formulate pathology test recommendation as a multi-label classification problem where each case is associated with multiple, interdependent tests. We propose an AI-based framework that applies classifier chains with logistic regression, decision trees, random forests, and their ensemble to capture label dependencies between tests. Experiments on an expert-curated dataset from a private pathology laboratory show that classifier-chain models outperform their independent counterparts, improving F1-score and reducing Hamming loss while maintaining high accuracy across common and rare tests. To enhance trust and transparency, we integrate SHAP-based explainable AI, providing symptom-level attributions that align with established clinical reasoning in most cases. The results demonstrate that classifier chains combined with SHAP offer an effective and interpretable approach for multi-label pathology test recommendation, with potential to support clinicians in selecting appropriate diagnostic tests at an early stage.