Transferring features learned from natural to medical images for classification is common. However, challenges arise due to the scarcity of certain medical image types and the feature disparities between natural and medical images. Two-step transfer learning has been recognized as a promising solution for this issue. However, choosing an appropriate intermediate domain would be critical in further improving the classification performance. In this work, we explore the effectiveness of using color fundus photographs of the diabetic retina dataset as an intermediate domain for two-step heterogeneous learning (THTL) to classify laryngeal vascular images with nine deep-learning models. Experiment results confirm that although the images in both the intermediate and target domains share vascularized characteristics, the accuracy is drastically reduced compared to one-step transfer learning, where only the last layer is fine-tuned (e.g., ResNet18 drops 14.7%, ResNet50 drops 14.8%). By analyzing the Layer Class Activation Maps (LayerCAM), we uncover a novel finding that the prevalent radial vascular pattern in the intermediate domain prevents learning the features of twisted and tangled vessels that distinguish the malignant class in the target domain. To address the performance drop, we propose the Step-Wise Fine-Tuning (SWFT) method on ResNet in the second step of THTL, resulting in substantial accuracy improvements. Compared to THTL's second step, where only the last layer is fine-tuned, accuracy increases by 26.1% for ResNet18 and 20.4% for ResNet50. Additionally, compared to training from scratch, using ImageNet as the source domain could slightly improve classification performance for laryngeal vascular, but the differences are insignificant.
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