Investigating Zero-Shot Diagnostic Pathology in Vision-Language Models with Efficient Prompt Design

Vision-language models (VLMs) have gained significant attention in computational pathology due to their multimodal learning capabilities that enhance big-data analytics of giga-pixel whole slide image (WSI). However, their sensitivity to large-scale clinical data, task formulations, and prompt design remains an open question, particularly in terms of diagnostic accuracy. In this paper, we present a systematic investigation and analysis of three state of the art VLMs for histopathology, namely Quilt-Net, Quilt-LLAVA, and CONCH, on an in-house digestive pathology dataset comprising 3,507 WSIs, each in giga-pixel form, across distinct tissue types. Through a structured ablative study on cancer invasiveness and dysplasia status, we develop a comprehensive prompt engineering framework that systematically varies domain specificity, anatomical precision, instructional framing, and output constraints. Our findings demonstrate that prompt engineering significantly impacts model performance, with the CONCH model achieving the highest accuracy when provided with precise anatomical references. Additionally, we identify the critical importance of anatomical context in histopathological image analysis, as performance consistently degraded when reducing anatomical precision. We also show that model complexity alone does not guarantee superior performance, as effective domain alignment and domain-specific training are critical. These results establish foundational guidelines for prompt engineering in computational pathology and highlight the potential of VLMs to enhance diagnostic accuracy when properly instructed with domain-appropriate prompts.

Segment Any Crack: Deep Semantic Segmentation Adaptation for Crack Detection

Image-based crack detection algorithms are increasingly in demand in infrastructure monitoring, as early detection of cracks is of paramount importance for timely maintenance planning. While deep learning has significantly advanced crack detection algorithms, existing models often require extensive labeled datasets and high computational costs for fine-tuning, limiting their adaptability across diverse conditions. This study introduces an efficient selective fine-tuning strategy, focusing on tuning normalization components, to enhance the adaptability of segmentation models for crack detection. The proposed method is applied to the Segment Anything Model (SAM) and five well-established segmentation models. Experimental results demonstrate that selective fine-tuning of only normalization parameters outperforms full fine-tuning and other common fine-tuning techniques in both performance and computational efficiency, while improving generalization. The proposed approach yields a SAM-based model, Segment Any Crack (SAC), achieving a 61.22\% F1-score and 44.13\% IoU on the OmniCrack30k benchmark dataset, along with the highest performance across three zero-shot datasets and the lowest standard deviation. The results highlight the effectiveness of the adaptation approach in improving segmentation accuracy while significantly reducing computational overhead.

Ultrasound Image Generation using Latent Diffusion Models

Diffusion models for image generation have been a subject of increasing interest due to their ability to generate diverse, high-quality images. Image generation has immense potential in medical imaging because open-source medical images are difficult to obtain compared to natural images, especially for rare conditions. The generated images can be used later to train classification and segmentation models. In this paper, we propose simulating realistic ultrasound (US) images by successive fine-tuning of large diffusion models on different publicly available databases. To do so, we fine-tuned Stable Diffusion, a state-of-the-art latent diffusion model, on BUSI (Breast US Images) an ultrasound breast image dataset. We successfully generated high-quality US images of the breast using simple prompts that specify the organ and pathology, which appeared realistic to three experienced US scientists and a US radiologist. Additionally, we provided user control by conditioning the model with segmentations through ControlNet. We will release the source code at http://code.sonography.ai/ to allow fast US image generation to the scientific community.

2DMamba: Efficient State Space Model for Image Representation with Applications on Giga-Pixel Whole Slide Image Classification

Efficiently modeling large 2D contexts is essential for various fields including Giga-Pixel Whole Slide Imaging (WSI) and remote sensing. Transformer-based models offer high parallelism but face challenges due to their quadratic complexity for handling long sequences. Recently, Mamba introduced a selective State Space Model (SSM) with linear complexity and high parallelism, enabling effective and efficient modeling of wide context in 1D sequences. However, extending Mamba to vision tasks, which inherently involve 2D structures, results in spatial discrepancies due to the limitations of 1D sequence processing. On the other hand, current 2D SSMs inherently model 2D structures but they suffer from prohibitively slow computation due to the lack of efficient parallel algorithms. In this work, we propose 2DMamba, a novel 2D selective SSM framework that incorporates the 2D spatial structure of images into Mamba, with a highly optimized hardware-aware operator, adopting both spatial continuity and computational efficiency. We validate the versatility of our approach on both WSIs and natural images. Extensive experiments on 10 public datasets for WSI classification and survival analysis show that 2DMamba~improves up to $2.48\%$ in AUC, $3.11\%$ in F1 score, $2.47\%$ in accuracy and $5.52\%$ in C-index. Additionally, integrating our method with VMamba for natural imaging yields $0.5$ to $0.7$ improvements in mIoU on the ADE20k semantic segmentation dataset, and $0.2\%$ accuracy improvement on ImageNet-1K classification dataset. Our code is available at https://github.com/AtlasAnalyticsLab/2DMamba.

Comparative Analysis of Diffusion Generative Models in Computational Pathology

Diffusion Generative Models (DGM) have rapidly surfaced as emerging topics in the field of computer vision, garnering significant interest across a wide array of deep learning applications. Despite their high computational demand, these models are extensively utilized for their superior sample quality and robust mode coverage. While research in diffusion generative models is advancing, exploration within the domain of computational pathology and its large-scale datasets has been comparatively gradual. Bridging the gap between the high-quality generation capabilities of Diffusion Generative Models and the intricate nature of pathology data, this paper presents an in-depth comparative analysis of diffusion methods applied to a pathology dataset. Our analysis extends to datasets with varying Fields of View (FOV), revealing that DGMs are highly effective in producing high-quality synthetic data. An ablative study is also conducted, followed by a detailed discussion on the impact of various methods on the synthesized histopathology images. One striking observation from our experiments is how the adjustment of image size during data generation can simulate varying fields of view. These findings underscore the potential of DGMs to enhance the quality and diversity of synthetic pathology data, especially when used with real data, ultimately increasing accuracy of deep learning models in histopathology. Code is available from https://github.com/AtlasAnalyticsLab/Diffusion4Path

Efficient Self-Supervised Barlow Twins from Limited Tissue Slide Cohorts for Colonic Pathology Diagnostics

Colorectal cancer (CRC) is one of the few cancers that have an established dysplasia-carcinoma sequence that benefits from screening. Everyone over 50 years of age in Canada is eligible for CRC screening. About 20\% of those people will undergo a biopsy for a pre-neoplastic polyp and, in many cases, multiple polyps. As such, these polyp biopsies make up the bulk of a pathologist's workload. Developing an efficient computational model to help screen these polyp biopsies can improve the pathologist's workflow and help guide their attention to critical areas on the slide. DL models face significant challenges in computational pathology (CPath) because of the gigapixel image size of whole-slide images and the scarcity of detailed annotated datasets. It is, therefore, crucial to leverage self-supervised learning (SSL) methods to alleviate the burden and cost of data annotation. However, current research lacks methods to apply SSL frameworks to analyze pathology data effectively. This paper aims to propose an optimized Barlow Twins framework for colorectal polyps screening. We adapt its hyperparameters, augmentation strategy and encoder to the specificity of the pathology data to enhance performance. Additionally, we investigate the best Field of View (FoV) for colorectal polyps screening and propose a new benchmark dataset for CRC screening, made of four types of colorectal polyps and normal tissue, by performing downstream tasking on MHIST and NCT-CRC-7K datasets. Furthermore, we show that the SSL representations are more meaningful and qualitative than the supervised ones and that Barlow Twins benefits from the Swin Transformer when applied to pathology data. Codes are avaialble from https://github.com/AtlasAnalyticsLab/PathBT.

Vision Mamba for Classification of Breast Ultrasound Images

Mamba-based models, VMamba and Vim, are a recent family of vision encoders that offer promising performance improvements in many computer vision tasks. This paper compares Mamba-based models with traditional Convolutional Neural Networks (CNNs) and Vision Transformers (ViTs) using the breast ultrasound BUSI and B datasets. Our evaluation, which includes multiple runs of experiments and statistical significance analysis, demonstrates that Mamba-based architectures frequently outperform CNN and ViT models with statistically significant results. These Mamba-based models effectively capture long-range dependencies while maintaining inductive biases, making them suitable for applications with limited data.

AdaFisher: Adaptive Second Order Optimization via Fisher Information

First-order optimization methods are currently the mainstream in training deep neural networks (DNNs). Optimizers like Adam incorporate limited curvature information by employing the diagonal matrix preconditioning of the stochastic gradient during the training. Despite their widespread, second-order optimization algorithms exhibit superior convergence properties compared to their first-order counterparts e.g. Adam and SGD. However, their practicality in training DNNs are still limited due to increased per-iteration computations and suboptimal accuracy compared to the first order methods. We present AdaFisher--an adaptive second-order optimizer that leverages a block-diagonal approximation to the Fisher information matrix for adaptive gradient preconditioning. AdaFisher aims to bridge the gap between enhanced convergence capabilities and computational efficiency in second-order optimization framework for training DNNs. Despite the slow pace of second-order optimizers, we showcase that AdaFisher can be reliably adopted for image classification, language modelling and stand out for its stability and robustness in hyperparameter tuning. We demonstrate that AdaFisher outperforms the SOTA optimizers in terms of both accuracy and convergence speed. Code available from \href{https://github.com/AtlasAnalyticsLab/AdaFisher}{https://github.com/AtlasAnalyticsLab/AdaFisher}

Vim4Path: Self-Supervised Vision Mamba for Histopathology Images

Representation learning from Gigapixel Whole Slide Images (WSI) poses a significant challenge in computational pathology due to the complicated nature of tissue structures and the scarcity of labeled data. Multi-instance learning methods have addressed this challenge, leveraging image patches to classify slides utilizing pretrained models using Self-Supervised Learning (SSL) approaches. The performance of both SSL and MIL methods relies on the architecture of the feature encoder. This paper proposes leveraging the Vision Mamba (Vim) architecture, inspired by state space models, within the DINO framework for representation learning in computational pathology. We evaluate the performance of Vim against Vision Transformers (ViT) on the Camelyon16 dataset for both patch-level and slide-level classification. Our findings highlight Vim's enhanced performance compared to ViT, particularly at smaller scales, where Vim achieves an 8.21 increase in ROC AUC for models of similar size. An explainability analysis further highlights Vim's capabilities, which reveals that Vim uniquely emulates the pathologist workflow-unlike ViT. This alignment with human expert analysis highlights Vim's potential in practical diagnostic settings and contributes significantly to developing effective representation-learning algorithms in computational pathology. We release the codes and pretrained weights at \url{https://github.com/AtlasAnalyticsLab/Vim4Path}.

End-to-End Supervised Multilabel Contrastive Learning

Multilabel representation learning is recognized as a challenging problem that can be associated with either label dependencies between object categories or data-related issues such as the inherent imbalance of positive/negative samples. Recent advances address these challenges from model- and data-centric viewpoints. In model-centric, the label correlation is obtained by an external model designs (e.g., graph CNN) to incorporate an inductive bias for training. However, they fail to design an end-to-end training framework, leading to high computational complexity. On the contrary, in data-centric, the realistic nature of the dataset is considered for improving the classification while ignoring the label dependencies. In this paper, we propose a new end-to-end training framework -- dubbed KMCL (Kernel-based Mutlilabel Contrastive Learning) -- to address the shortcomings of both model- and data-centric designs. The KMCL first transforms the embedded features into a mixture of exponential kernels in Gaussian RKHS. It is then followed by encoding an objective loss that is comprised of (a) reconstruction loss to reconstruct kernel representation, (b) asymmetric classification loss to address the inherent imbalance problem, and (c) contrastive loss to capture label correlation. The KMCL models the uncertainty of the feature encoder while maintaining a low computational footprint. Extensive experiments are conducted on image classification tasks to showcase the consistent improvements of KMCL over the SOTA methods. PyTorch implementation is provided in \url{https://github.com/mahdihosseini/KMCL}.