Longitudinal Risk Prediction in Mammography with Privileged History Distillation

Breast cancer remains a leading cause of cancer-related mortality worldwide. Longitudinal mammography risk prediction models improve multi-year breast cancer risk prediction based on prior screening exams. However, in real-world clinical practice, longitudinal histories are often incomplete, irregular, or unavailable due to missed screenings, first-time examinations, heterogeneous acquisition schedules, or archival constraints. The absence of prior exams degrades the performance of longitudinal risk models and limits their practical applicability. While substantial longitudinal history is available during training, prior exams are commonly absent at test time. In this paper, we address missing history at inference time and propose a longitudinal risk prediction method that uses mammography history as privileged information during training and distills its prognostic value into a student model that only requires the current exam at inference time. The key idea is a privileged multi-teacher distillation scheme with horizon-specific teachers: each teacher is trained on the full longitudinal history to specialize in one prediction horizon, while the student receives only a reconstructed history derived from the current exam. This allows the student to inherit horizon-dependent longitudinal risk cues without requiring prior screening exams at deployment. Our new Privileged History Distillation (PHD) method is validated on a large longitudinal mammography dataset with multi-year cancer outcomes, CSAW-CC, comparing full-history and no-history baselines to their distilled counterparts. Using time-dependent AUC across horizons, our privileged history distillation method markedly improves the performance of long-horizon prediction over no-history models and is comparable to that of full-history models, while using only the current exam at inference time.

Adaptation of Weakly Supervised Localization in Histopathology by Debiasing Predictions

Weakly Supervised Object Localization (WSOL) models enable joint classification and region-of-interest localization in histology images using only image-class supervision. When deployed in a target domain, distributions shift remains a major cause of performance degradation, especially when applied on new organs or institutions with different staining protocols and scanner characteristics. Under stronger cross-domain shifts, WSOL predictions can become biased toward dominant classes, producing highly skewed pseudo-label distributions in the target domain. Source-Free (Unsupervised) Domain Adaptation (SFDA) methods are commonly employed to address domain shift. However, because they rely on self-training, the initial bias is reinforced over training iterations, degrading both classification and localization tasks. We identify this amplification of prediction bias as a primary obstacle to the SFDA of WSOL models in histopathology. This paper introduces \sfdadep, a method inspired by machine unlearning that formulates SFDA as an iterative process of identifying and correcting prediction bias. It periodically identifies target images from over-predicted classes and selectively reduces the predictive confidence for uncertain (high entropy) images, while preserving confident predictions. This process reduces the drift of decision boundaries and bias toward dominant classes. A jointly optimized pixel-level classifier further restores discriminative localization features under distribution shift. Extensive experiments on cross-organ and -center histopathology benchmarks (glas, CAMELYON-16, CAMELYON-17) with several WSOL models show that SFDA-DeP consistently improves classification and localization over state-of-the-art SFDA baselines. {\small Code: \href{https://anonymous.4open.science/r/SFDA-DeP-1797/}{anonymous.4open.science/r/SFDA-DeP-1797/}}

CLIP-IT: CLIP-based Pairing for Histology Images Classification

Multimodal learning has shown significant promise for improving medical image analysis by integrating information from complementary data sources. This is widely employed for training vision-language models (VLMs) for cancer detection based on histology images and text reports. However, one of the main limitations in training these VLMs is the requirement for large paired datasets, raising concerns over privacy, and data collection, annotation, and maintenance costs. To address this challenge, we introduce CLIP-IT method to train a vision backbone model to classify histology images by pairing them with privileged textual information from an external source. At first, the modality pairing step relies on a CLIP-based model to match histology images with semantically relevant textual report data from external sources, creating an augmented multimodal dataset without the need for manually paired samples. Then, we propose a multimodal training procedure that distills the knowledge from the paired text modality to the unimodal image classifier for enhanced performance without the need for the textual data during inference. A parameter-efficient fine-tuning method is used to efficiently address the misalignment between the main (image) and paired (text) modalities. During inference, the improved unimodal histology classifier is used, with only minimal additional computational complexity. Our experiments on challenging PCAM, CRC, and BACH histology image datasets show that CLIP-IT can provide a cost-effective approach to leverage privileged textual information and outperform unimodal classifiers for histology.