BagShift: Measuring How Patch Selection Changes the Evidence Seen by Whole-Slide MIL

Whole-slide multiple-instance learning (MIL) observes only the patches admitted by its selector. Deployment can alter this selector through compute limits, tissue masking, or regional workflows, even when the patch count is unchanged. We introduce BagShift, a paired protocol that changes the selector for the same case while holding its features and predictor fixed, thereby isolating selector response from case mix. With equal 128-patch budgets, sampling across the tissue or concentrating around one coordinate exposes markedly different evidence: on PANDA, the two views reduce quadratic weighted kappa by 1.57 and 17.96 points, respectively (QWK reported on the $\times100$ scale). On CAMELYON16, lesion annotations withheld from model development show that localized views retain tumor in only 10.0\% of micrometastatic observations, and matched exposure does not consistently recover the loss. The same fixed-count stressor produces a much smaller response on external lung subtyping, although differences in relative coverage make cross-task severity descriptive. When repeated localized observations are available, unioning their patches before one nonlinear MIL pass improves PANDA QWK by 7.87 points over averaging regional predictions. Patch count specifies computation, not observed evidence; deployment evaluations should report both what a selector preserves and how repeated observations are aggregated.

HiPath: Hierarchical Vision-Language Alignment for Structured Pathology Report Prediction

Pathology reports are structured, multi-granular documents encoding diagnostic conclusions, histological grades, and ancillary test results across one or more anatomical sites; yet existing pathology vision-language models (VLMs) reduce this output to a flat label or free-form text. We present HiPath, a lightweight VLM framework built on frozen UNI2 and Qwen3 backbones that treats structured report prediction as its primary training objective. Three trainable modules totalling 15M parameters address complementary aspects of the problem: a Hierarchical Patch Aggregator (HiPA) for multi-image visual encoding, Hierarchical Contrastive Learning (HiCL) for cross-modal alignment via optimal transport, and Slot-based Masked Diagnosis Prediction (Slot-MDP) for structured diagnosis generation. Trained on 749K real-world Chinese pathology cases from three hospitals, HiPath achieves 68.9% strict and 74.7% clinically acceptable accuracy with a 97.3% safety rate, outperforming all baselines under the same frozen backbone. Cross-hospital evaluation confirms generalisation with only a 3.4pp drop in strict accuracy while maintaining 97.1% safety.

Towards Trustworthy Selective Generation: Reliability-Guided Diffusion for Ultra-Low-Field to High-Field MRI Synthesis

Low-field to high-field MRI synthesis has emerged as a cost-effective strategy to enhance image quality under hardware and acquisition constraints, particularly in scenarios where access to high-field scanners is limited or impractical. Despite recent progress in diffusion models, diffusion-based approaches often struggle to balance fine-detail recovery and structural fidelity. In particular, the uncontrolled generation of high-resolution details in structurally ambiguous regions may introduce anatomically inconsistent patterns, such as spurious edges or artificial texture variations. These artifacts can bias downstream quantitative analysis. For example, they may cause inaccurate tissue boundary delineation or erroneous volumetric estimation, ultimately reducing clinical trust in synthesized images. These limitations highlight the need for generative models that are not only visually accurate but also spatially reliable and anatomically consistent. To address this issue, we propose a reliability-aware diffusion framework (ReDiff) that improves synthesis robustness at both the sampling and post-generation stages. Specifically, we introduce a reliability-guided sampling strategy to suppress unreliable responses during the denoising process. We further develop an uncertainty-aware multi-candidate selection scheme to enhance the reliability of the final prediction. Experiments on multi-center MRI datasets demonstrate improved structural fidelity and reduced artifacts compared with state-of-the-art methods.