PathSelect: Sequential Token Selection for Whole Slide Pathology

Gigapixel Whole-Slide Images (WSIs) present a fundamental computational bottleneck for vision-language models (VLMs) due to extreme sequence lengths. Existing approaches predominantly rely on spatial sampling or training-free pruning, which risk diluting weak but informative signals, leading to the loss of critical diagnostic evidence due to the spatially diffuse nature of pathological cues. We reformulate WSI token pruning as a sequential selection process, enabling the model to autonomously learn an optimal routing strategy rather than relying on static heuristics. We herein propose a decoupled routing framework integrated as an active plugin into the fully pre-trained SlideChat base model, leaving both the slide encoder and large language model frozen. To provide continuous gradients for the non-differentiable pruning operation during training, we introduce PathSelect. PathSelect employs a variance-preserving noise gate to modulate each patch's information flow via a differentiable Soft Top-K operator, paired with a diagonal-attention Denoiser that recovers the perturbed representations without semantic leakage. At inference, the PathSelect module is entirely detached. Relying solely on the trained Scorer, a deterministic Hard Top-K operator executes adaptive, data-dependent trajectory termination, significantly accelerating downstream generative processing with exceptionally low sequential token selection latency. Driven by an empirical average of only 44.86 tokens under a maximum constraint of K = 128, our framework achieves 74.00% overall accuracy on SlideBench (TCGA), representing an approximate 36.6x spatial token reduction relative to the uncompressed baseline average while consistently outperforming sampling-based counterparts.

Multimodal Model for Computational Pathology:Representation Learning and Image Compression

Whole slide imaging (WSI) has transformed digital pathology by enabling computational analysis of gigapixel histopathology images. Recent foundation model advances have accelerated progress in computational pathology, facilitating joint reasoning across pathology images, clinical reports, and structured data. Despite this progress, challenges remain: the extreme resolution of WSIs creates computational hurdles for visual learning; limited expert annotations constrain supervised approaches; integrating multimodal information while preserving biological interpretability remains difficult; and the opacity of modeling ultra-long visual sequences hinders clinical transparency. This review comprehensively surveys recent advances in multimodal computational pathology. We systematically analyze four research directions: (1) self-supervised representation learning and structure-aware token compression for WSIs; (2) multimodal data generation and augmentation; (3) parameter-efficient adaptation and reasoning-enhanced few-shot learning; and (4) multi-agent collaborative reasoning for trustworthy diagnosis. We specifically examine how token compression enables cross-scale modeling and how multi-agent mechanisms simulate a pathologist's "Chain of Thought" across magnifications to achieve uncertainty-aware evidence fusion. Finally, we discuss open challenges and argue that future progress depends on unified multimodal frameworks integrating high-resolution visual data with clinical and biomedical knowledge to support interpretable and safe AI-assisted diagnosis.