Mitosis Detection in the Wild: Multi-Tumor and Context-Aware Generalization in the MIDOG 2025 Challenge

Automated mitosis detection is a well-established task in computational pathology. While previous benchmarks focused on scanner-induced domain shift, clinical "real-world" application requires models to be robust across the vast variance to be expected in the histological landscape. The MItosis DOmain Generalization (MIDOG) 2025 challenge was designed to evaluate algorithmic performance across unprecedented biological and contextual diversity. We curated a test dataset of 365 cases, encompassing 12 distinct human, canine and feline tumor types, digitized across multiple scanning platforms. Moving beyond hand-selected hotspots, the challenge required detection also in random tissue areas (representative of the whole slide detection situation) and challenging areas (areas rich in hard negatives). In the second track, we introduced the classification of atypical mitotic figures (AMFs). There were 18 teams submitting to the detection track, with F1 scores ranging up to 0.740. In the AMF detection track, we had 21 submissions with balanced accuracy values up to 0.908. Our analysis reveals that while most models perform reliably in traditional hotspots, significant performance degradation occurs in challenging ROIs, where false positive rates tripled. Furthermore, performance varied significantly across the 12 tumor types, highlighting "blind spots" in current state-of-the-art architectures when encountering rare or highly pleomorphic malignancies. Moreover, we evaluated the effectiveness of ensembling and found a mean increases of 1.5 and 1.3 percentage points in F1 score and balanced accuracy, respectively. In contrast, TTA showed no relevant improvement. MIDOG 2025 demonstrates that "in the wild" mitosis detection remains a significant hurdle. The transition from hotspot-only evaluation to a multi-contextual framework provides a more realistic proxy for clinical reliability.

Efficient Fine-Tuning of DINOv3 Pretrained on Natural Images for Atypical Mitotic Figure Classification in MIDOG 2025

Atypical mitotic figures (AMFs) are markers of abnormal cell division associated with poor prognosis, yet their detection remains difficult due to low prevalence, subtle morphology, and inter-observer variability. The MIDOG 2025 challenge introduces a benchmark for AMF classification across multiple domains. In this work, we evaluate the recently published DINOv3-H+ vision transformer, pretrained on natural images, which we fine-tuned using low-rank adaptation (LoRA, 650k trainable parameters) and extensive augmentation. Despite the domain gap, DINOv3 transfers effectively to histopathology, achieving a balanced accuracy of 0.8871 on the preliminary test set. These results highlight the robustness of DINOv3 pretraining and show that, when combined with parameter-efficient fine-tuning, it provides a strong baseline for atypical mitosis classification in MIDOG 2025.