Hierarchical Multi-Scale Graph Learning with Knowledge-Guided Attention for Whole-Slide Image Survival Analysis

We propose a Hierarchical Multi-scale Knowledge-aware Graph Network (HMKGN) that models multi-scale interactions and spatially hierarchical relationships within whole-slide images (WSIs) for cancer prognostication. Unlike conventional attention-based MIL, which ignores spatial organization, or graph-based MIL, which relies on static handcrafted graphs, HMKGN enforces a hierarchical structure with spatial locality constraints, wherein local cellular-level dynamic graphs aggregate spatially proximate patches within each region of interest (ROI) and a global slide-level dynamic graph integrates ROI-level features into WSI-level representations. Moreover, multi-scale integration at the ROI level combines coarse contextual features from broader views with fine-grained structural representations from local patch-graph aggregation. We evaluate HMKGN on four TCGA cohorts (KIRC, LGG, PAAD, and STAD; N=513, 487, 138, and 370) for survival prediction. It consistently outperforms existing MIL-based models, yielding improved concordance indices (10.85% better) and statistically significant stratification of patient survival risk (log-rank p < 0.05).

Pathological Primitive Segmentation Based on Visual Foundation Model with Zero-Shot Mask Generation

Medical image processing usually requires a model trained with carefully crafted datasets due to unique image characteristics and domain-specific challenges, especially in pathology. Primitive detection and segmentation in digitized tissue samples are essential for objective and automated diagnosis and prognosis of cancer. SAM (Segment Anything Model) has recently been developed to segment general objects from natural images with high accuracy, but it requires human prompts to generate masks. In this work, we present a novel approach that adapts pre-trained natural image encoders of SAM for detection-based region proposals. Regions proposed by a pre-trained encoder are sent to cascaded feature propagation layers for projection. Then, local semantic and global context is aggregated from multi-scale for bounding box localization and classification. Finally, the SAM decoder uses the identified bounding boxes as essential prompts to generate a comprehensive primitive segmentation map. The entire base framework, SAM, requires no additional training or fine-tuning but could produce an end-to-end result for two fundamental segmentation tasks in pathology. Our method compares with state-of-the-art models in F1 score for nuclei detection and binary/multiclass panoptic(bPQ/mPQ) and mask quality(dice) for segmentation quality on the PanNuke dataset while offering end-to-end efficiency. Our model also achieves remarkable Average Precision (+4.5%) on the secondary dataset (HuBMAP Kidney) compared to Faster RCNN. The code is publicly available at https://github.com/learner-codec/autoprom_sam.