Are Compact Rationales Free? Measuring Tile Selection Headroom in Frozen WSI-MIL

Whole-slide image (WSI) multiple instance learning (MIL) classifiers can achieve strong slide-level AUC while leaving the full-bag prediction opaque. Attention scores are widely reused as post-hoc explanations, but high attention can reflect aggregation preference rather than a compact, model-sufficient rationale. We study post-hoc rationale highlighting for frozen WSI-MIL: given a trained classifier, can its slide-level prediction be recovered from a compact, output-consistent tile subset without retraining the backbone? We instantiate this with Finding Optimal Contextual Instances (FOCI), a lightweight rationale-readout layer over a frozen MIL backbone. FOCI is trained with model-output sufficiency and exclusion objectives over keep/drop tile subsets, evaluated with an insertion-style Sequential Reveal Protocol (SRP) adapted to WSI-MIL, and summarized by the Selection Headroom Index (SHI). Across three WSI benchmarks and seven MIL backbones, FOCI reveals that compact rationales are selection-headroom dependent: transformer and multi-branch attention aggregators can admit compact rationales, near-minimal attention-pooling baselines enter a selection-saturation regime, and hard-selection backbones can conflict with an external readout. For TransMIL, relative to its documented CLS-proxy ranking, FOCI reduces the Minimum Sufficient K (MSK) tile count by 32-56% across benchmarks, while ACMIL+FOCI attains the highest mean SHI (+0.465). Deletion-based perturbation and selected-only downstream evaluation provide complementary checks. These results position FOCI as a model-level interpretability and audit layer: selected tiles are not claims of clinical or pathologist-level diagnostic sufficiency, but candidate rationales that offer a compact, reviewable view of when a frozen MIL prediction can be localized to a small output-consistent subset.

ReaMIL: Reasoning- and Evidence-Aware Multiple Instance Learning for Whole-Slide Histopathology

We introduce ReaMIL (Reasoning- and Evidence-Aware MIL), a multiple instance learning approach for whole-slide histopathology that adds a light selection head to a strong MIL backbone. The head produces soft per-tile gates and is trained with a budgeted-sufficiency objective: a hinge loss that enforces the true-class probability to be $\geq τ$ using only the kept evidence, under a sparsity budget on the number of selected tiles. The budgeted-sufficiency objective yields small, spatially compact evidence sets without sacrificing baseline performance. Across TCGA-NSCLC (LUAD vs. LUSC), TCGA-BRCA (IDC vs. Others), and PANDA, ReaMIL matches or slightly improves baseline AUC and provides quantitative evidence-efficiency diagnostics. On NSCLC, it attains AUC 0.983 with a mean minimal sufficient K (MSK) $\approx 8.2$ tiles at $τ= 0.90$ and AUKC $\approx 0.864$, showing that class confidence rises sharply and stabilizes once a small set of tiles is kept. The method requires no extra supervision, integrates seamlessly with standard MIL training, and naturally yields slide-level overlays. We report accuracy alongside MSK, AUKC, and contiguity for rigorous evaluation of model behavior on WSIs.