Chromosome analysis is essential for diagnosing genetic disorders. For hematologic malignancies, identification of somatic clonal aberrations by karyotype analysis remains the standard of care. However, karyotyping is costly and time-consuming because of the largely manual process and the expertise required in identifying and annotating aberrations. Efforts to automate karyotype analysis to date fell short in aberration detection. Using a training set of ~10k patient specimens and ~50k karyograms from over 5 years from the Fred Hutchinson Cancer Center, we created a labeled set of images representing individual chromosomes. These individual chromosomes were used to train and assess deep learning models for classifying the 24 human chromosomes and identifying chromosomal aberrations. The top-accuracy models utilized the recently introduced Topological Vision Transformers (TopViTs) with 2-level-block-Toeplitz masking, to incorporate structural inductive bias. TopViT outperformed CNN (Inception) models with >99.3% accuracy for chromosome identification, and exhibited accuracies >99% for aberration detection in most aberrations. Notably, we were able to show high-quality performance even in "few shot" learning scenarios. Incorporating the definition of clonality substantially improved both precision and recall (sensitivity). When applied to "zero shot" scenarios, the model captured aberrations without training, with perfect precision at >50% recall. Together these results show that modern deep learning models can approach expert-level performance for chromosome aberration detection. To our knowledge, this is the first study demonstrating the downstream effectiveness of TopViTs. These results open up exciting opportunities for not only expediting patient results but providing a scalable technology for early screening of low-abundance chromosomal lesions.

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