Monte Carlo Dropout Uncertainty and Entropy-Thresholded Selective Prediction for Architecture-Agnostic Brain Tumor MRI Triage
Deep networks now subtype brain tumors on MRI about as well as specialist readers, yet accuracy is not what keeps them out of the clinic. What matters at the point of care is whether a model's confidence can be trusted to flag the cases it is likely to misclassify and defer them to a human. Deterministic estimates cannot: an auxiliary confidence head trained alongside the classifier collapses to a near-constant output that says nothing about correctness. This study proposes an uncertainty-first pipeline for four-class brain tumor MRI (glioma, meningioma, pituitary, no tumor) that reads predictive uncertainty from Monte Carlo (MC) Dropout over T = 20 passes and turns the resulting entropy into an explicit rule for deferring uncertain cases to a radiologist. We partitioned 7,200 images by perceptual-hash cluster, closing the near-duplicate leakage that inflates accuracy under naive splitting, and evaluated the pipeline on ViT-B/16 and ResNet-50 across five seeds along three axes: discrimination, calibration, and selective prediction. Both discriminate strongly (macro-AUC 0.994; accuracy 0.962 and 0.964), and no seed separates them (0 of 5 significant, p < 0.05), so the result is driven by the uncertainty pipeline, not the network. A single temperature scalar pulls the deterministic softmax into tight calibration (expected calibration error 0.016-0.020), and deferring the most uncertain 5% of cases lifts accuracy on the rest to about 0.98 on both (area under the risk-coverage curve 0.010-0.011). MC-Dropout uncertainty here is thus calibrated, non-collapsing, and directly actionable through a concrete deferral rule, providing an architecture-agnostic basis for calibrated, defer-to-human brain tumor MRI triage under internal validation.