LRMIL: Efficient Low-Resolution Multiple Instance Learning via High-Resolution Knowledge Distillation for Whole Slide Image Classification

Multiple instance learning (MIL) has become a standard paradigm for whole slide image (WSI) analysis in digital pathology, as it enables slide-level prediction without dense annotations. Existing MIL methods typically rely on exhaustive extraction and encoding of high-resolution patches. However, this practice suffers from two critical limitations in real-world clinical settings: it struggles to capture global visual cues at lower magnifications, and incurs substantial computational overhead due to the massive number of high-resolution patches per slide. To address these limitations, we propose an efficient low-resolution multiple instance learning (LRMIL) framework that transfers high-resolution knowledge to low-resolution representations. LRMIL adopts a two-stage distillation strategy. First, patch-level cross-resolution distillation aligns low-resolution patch embeddings with high-resolution representations. Second, slide-level knowledge distillation trains a low-resolution student MIL model under both slide-level supervision and teacher guidance. At inference time, LRMIL operates exclusively on low-resolution patches, substantially reducing data preprocessing and computational cost. Extensive experiments on multiple WSI benchmarks demonstrate that LRMIL consistently outperforms state-of-the-art MIL methods while achieving more efficient inference. These results highlight LRMIL as a practical and scalable solution for WSI analysis in clinical pathology.

WISE-FUSE: Efficient Whole Slide Image Encoding via Coarse-to-Fine Patch Selection with VLM and LLM Knowledge Fusion

Whole slide images (WSIs) in computational pathology (CPath) pose a major computational challenge due to their gigapixel scale, often requiring the processing of tens to hundreds of thousands of high-resolution patches per slide. This results in prohibitive encoding costs, with preprocessing and training times extending to days or even weeks-making WSI encoding the most significant bottleneck in real-world deployment. In this work, we propose WISE-FUSE, an adaptive WSI encoding framework that leverages pathology-domain vision-language models and large language models to address this challenge by selectively processing diagnostically relevant regions. WISE-FUSE first computes similarity scores between low-resolution patches and class-specific textual descriptions using a knowledge distillation mechanism that preserves fine-grained diagnostic features. Based on these similarity scores, we select a small subset of informative regions for the target task, which quickly eliminates irrelevant patches at the coarse level. The corresponding high-resolution patches are then selectively encoded and fused with textual embeddings to reinforce diagnostic context. Extensive experiments demonstrate that WISE-FUSE reduces WSI encoding time by over threefold while achieving diagnostic performance comparable to or surpassing that of exhaustive patch processing, offering a scalable and practical solution for CPath.