Thinking in Scales: Accelerating Gigapixel Pathology Image Analysis via Adaptive Continuous Reasoning

Traditional whole slide image (WSI) analysis methods typically rely on the multiple instance learning (MIL) paradigm, which extracts patch-level features at high magnification and aggregates them for slide-level prediction. However, such exhaustive patch-level processing is computationally expensive, severely limiting the efficiency and scalability of WSI analysis. To address this challenge, we propose PathCTM (a Pathology-oriented Continuous Thought Model) that enables token-efficient scale-space continuous reasoning for gigapixel WSIs. PathCTM formulates diagnostic inference as a dynamic sequential information pursuit. It progressively transitions from low-magnification global to high-magnification local inspection, and adaptively terminates inference when sufficient evidence is gathered to effectively bound decision uncertainty. Specifically, it uses conditional computation for dynamic scale switching with attention-guided region pruning, coupled with confidence-aware early stopping. Extensive experiments demonstrate that, compared with standard MIL-based methods, PathCTM reduces the number of required image patches by 95.95% and shortens inference time by approximately 95.62%, while maintaining AUC without degradation. Code is available at https://github.com/JSGe-AI/PathCTM.

The Butterfly Effect in Pathology: Exploring Security in Pathology Foundation Models

With the widespread adoption of pathology foundation models in both research and clinical decision support systems, exploring their security has become a critical concern. However, despite their growing impact, the vulnerability of these models to adversarial attacks remains largely unexplored. In this work, we present the first systematic investigation into the security of pathology foundation models for whole slide image~(WSI) analysis against adversarial attacks. Specifically, we introduce the principle of \textit{local perturbation with global impact} and propose a label-free attack framework that operates without requiring access to downstream task labels. Under this attack framework, we revise four classical white-box attack methods and redefine the perturbation budget based on the characteristics of WSI. We conduct comprehensive experiments on three representative pathology foundation models across five datasets and six downstream tasks. Despite modifying only 0.1\% of patches per slide with imperceptible noise, our attack leads to downstream accuracy degradation that can reach up to 20\% in the worst cases. Furthermore, we analyze key factors that influence attack success, explore the relationship between patch-level vulnerability and semantic content, and conduct a preliminary investigation into potential defence strategies. These findings lay the groundwork for future research on the adversarial robustness and reliable deployment of pathology foundation models. Our code is publicly available at: https://github.com/Jiashuai-Liu-hmos/Attack-WSI-pathology-foundation-models.

ST-Prompt Guided Histological Hypergraph Learning for Spatial Gene Expression Prediction

Spatial Transcriptomics (ST) reveals the spatial distribution of gene expression in tissues, offering critical insights into biological processes and disease mechanisms. However, predicting ST from H\&E-stained histology images is challenging due to the heterogeneous relationship between histomorphology and gene expression, which arises from substantial variability across different patients and tissue sections. A more practical and valuable approach is to utilize ST data from a few local regions to predict the spatial transcriptomic landscape across the remaining regions in H&E slides. In response, we propose PHG2ST, an ST-prompt guided histological hypergraph learning framework, which leverages sparse ST signals as prompts to guide histological hypergraph learning for global spatial gene expression prediction. Our framework fuses histological hypergraph representations at multiple scales through a masked ST-prompt encoding mechanism, improving robustness and generalizability. Benchmark evaluations on two public ST datasets demonstrate that PHG2ST outperforms the existing state-of-the-art methods and closely aligns with the ground truth. These results underscore the potential of leveraging sparse local ST data for scalable and cost-effective spatial gene expression mapping in real-world biomedical applications.