CorePath: A Breast-Specialized Pathology Foundation Model for Core Needle Biopsy Diagnosis and Risk-Controlled Report Generation

Breast core needle biopsy (CNB) is central to breast cancer diagnosis yet remains challenging because limited tissue sampling, lesion heterogeneity, and subtle morphologic overlap can obscure subtype distinctions. We developed CorePath, a breast-specialized multimodal pathology foundation model fine-tuned from PRISM using 7901 paired CNB whole-slide images and diagnostic reports from two centers. Evaluated across six CNB cohorts and two public breast pathology benchmarks without task-specific retraining, CorePath consistently outperformed PRISM across cancer detection, invasion assessment, and histological subtyping. It achieved weighted area under the receiver operating characteristic curves (AUCs) of 0.9526-0.9735 for five-class CNB histological subtyping across private centers. On public benchmarks, CorePath outperformed leading pathology foundation models, achieving the highest weighted AUCs of 0.7780 for BCNB invasive carcinoma subtyping, 0.8178 for BRACS lesion stratification, and 0.8252 for BRACS fine-grained classification. In report generation, CorePath reduced the overall non-breast hallucinations from 30.1% to 2.8%, demonstrating improved domain fidelity after breast-specific adaptation. CorePath-CRG further combined conformal subtype-confidence gating with Learn-Then-Test risk control to enable selective report release, subtype-level fallback, and deferral. CorePath-CRG achieved zero non-breast hallucinations among released outputs and showed the strongest overall performance in pathologist-validated LLM-based Evaluation Scores and quantitative report-generation metrics across most centers. These results demonstrate that domain-specialized foundation models with statistical risk control offer a promising approach for accurate breast CNB diagnosis and reliable report generation.

Denoising Mutual Knowledge Distillation in Bi-Directional Multiple Instance Learning

Multiple Instance Learning is the predominant method for Whole Slide Image classification in digital pathology, enabling the use of slide-level labels to supervise model training. Although MIL eliminates the tedious fine-grained annotation process for supervised learning, whether it can learn accurate bag- and instance-level classifiers remains a question. To address the issue, instance-level classifiers and instance masks were incorporated to ground the prediction on supporting patches. These methods, while practically improving the performance of MIL methods, may potentially introduce noisy labels. We propose to bridge the gap between commonly used MIL and fully supervised learning by augmenting both the bag- and instance-level learning processes with pseudo-label correction capabilities elicited from weak to strong generalization techniques. The proposed algorithm improves the performance of dual-level MIL algorithms on both bag- and instance-level predictions. Experiments on public pathology datasets showcase the advantage of the proposed methods.