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.

Do Pathology Vision-Language Models Truly See Pathology?

Pathology vision-language models (VLMs) have recently progressed rapidly and are commonly evaluated by answer accuracy on pathology VQA benchmarks. However, we dig into current evaluations and identify three overlooked issues: 1) Visual evidence is not always necessary. For instance, Gemini-3-Pro achieves 53.5% average accuracy across 5 VQA benchmarks without any visual input. 2) Domain training can improve accuracy without proportional gains in visual binding. Compared with Qwen2.5-VL-7B, Patho-R1-7B exhibits a 5.8-point lower multimodal gain and a 3.7-point lower attention IoU. 3) Entity-level attention is diffuse and weakly query-specific. On PathVG, attention maps remain highly correlated across different entity queries. These issues can lead to substantial misjudgments of pathology VLMs' actual multimodal capabilities. To this end, we present PathBind, a benchmark comprising 2,600 samples: PathBind-VQA with 1,500 questions across six dimensions, PathBind-PTA with 600 questions from a private pathology teaching atlas, and PathBind-Grounding with 500 expert-curated region-level samples. Each component undergoes task-specific automated filtering and expert review to reduce textual shortcuts and improve entity-region correspondence. We evaluate 18 representative VLMs on VQA samples of PathBind and five existing pathology VQA benchmarks, and further evaluate 10 VLMs on PathBind-Grounding and PathVG. Results show that current pathology VLMs still exhibit a substantial gap between answer-side performance and visual-semantic binding.

Accelerating Byzantine-Robust Distributed Learning with Compressed Communication via Double Momentum and Variance Reduction

In collaborative and distributed learning, Byzantine robustness reflects a major facet of optimization algorithms. Such distributed algorithms are often accompanied by transmitting a large number of parameters, so communication compression is essential for an effective solution. In this paper, we propose Byz-DM21, a novel Byzantine-robust and communication-efficient stochastic distributed learning algorithm. Our key innovation is a novel gradient estimator based on a double-momentum mechanism, integrating recent advancements in error feedback techniques. Using this estimator, we design both standard and accelerated algorithms that eliminate the need for large batch sizes while maintaining robustness against Byzantine workers. We prove that the Byz-DM21 algorithm has a smaller neighborhood size and converges to $\varepsilon$-stationary points in $\mathcal{O}(\varepsilon^{-4})$ iterations. To further enhance efficiency, we introduce a distributed variant called Byz-VR-DM21, which incorporates local variance reduction at each node to progressively eliminate variance from random approximations. We show that Byz-VR-DM21 provably converges to $\varepsilon$-stationary points in $\mathcal{O}(\varepsilon^{-3 })$ iterations. Additionally, we extend our results to the case where the functions satisfy the Polyak-Łojasiewicz condition. Finally, numerical experiments demonstrate the effectiveness of the proposed method.

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.

Patho-R1: A Multimodal Reinforcement Learning-Based Pathology Expert Reasoner

Recent advances in vision language models (VLMs) have enabled broad progress in the general medical field. However, pathology still remains a more challenging subdomain, with current pathology specific VLMs exhibiting limitations in both diagnostic accuracy and reasoning plausibility. Such shortcomings are largely attributable to the nature of current pathology datasets, which are primarily composed of image description pairs that lack the depth and structured diagnostic paradigms employed by real world pathologists. In this study, we leverage pathology textbooks and real world pathology experts to construct high-quality, reasoning-oriented datasets. Building on this, we introduce Patho-R1, a multimodal RL-based pathology Reasoner, trained through a three-stage pipeline: (1) continued pretraining on 3.5 million image-text pairs for knowledge infusion; (2) supervised fine-tuning on 500k high-quality Chain-of-Thought samples for reasoning incentivizing; (3) reinforcement learning using Group Relative Policy Optimization and Decoupled Clip and Dynamic sAmpling Policy Optimization strategies for multimodal reasoning quality refinement. To further assess the alignment quality of our dataset, we propose PathoCLIP, trained on the same figure-caption corpus used for continued pretraining. Comprehensive experimental results demonstrate that both PathoCLIP and Patho-R1 achieve robust performance across a wide range of pathology-related tasks, including zero-shot classification, cross-modal retrieval, Visual Question Answering, and Multiple Choice Question. Our project is available at the Patho-R1 repository: https://github.com/Wenchuan-Zhang/Patho-R1.

Byzantine-Robust and Communication-Efficient Distributed Learning via Compressed Momentum Filtering

Distributed learning has become the standard approach for training large-scale machine learning models across private data silos. While distributed learning enhances privacy preservation and training efficiency, it faces critical challenges related to Byzantine robustness and communication reduction. Existing Byzantine-robust and communication-efficient methods rely on full gradient information either at every iteration or at certain iterations with a probability, and they only converge to an unnecessarily large neighborhood around the solution. Motivated by these issues, we propose a novel Byzantine-robust and communication-efficient stochastic distributed learning method that imposes no requirements on batch size and converges to a smaller neighborhood around the optimal solution than all existing methods, aligning with the theoretical lower bound. Our key innovation is leveraging Polyak Momentum to mitigate the noise caused by both biased compressors and stochastic gradients, thus defending against Byzantine workers under information compression. We provide proof of tight complexity bounds for our algorithm in the context of non-convex smooth loss functions, demonstrating that these bounds match the lower bounds in Byzantine-free scenarios. Finally, we validate the practical significance of our algorithm through an extensive series of experiments, benchmarking its performance on both binary classification and image classification tasks.

LiD-FL: Towards List-Decodable Federated Learning

Federated learning is often used in environments with many unverified participants. Therefore, federated learning under adversarial attacks receives significant attention. This paper proposes an algorithmic framework for list-decodable federated learning, where a central server maintains a list of models, with at least one guaranteed to perform well. The framework has no strict restriction on the fraction of honest workers, extending the applicability of Byzantine federated learning to the scenario with more than half adversaries. Under proper assumptions on the loss function, we prove a convergence theorem for our method. Experimental results, including image classification tasks with both convex and non-convex losses, demonstrate that the proposed algorithm can withstand the malicious majority under various attacks.

Near-Optimal Resilient Aggregation Rules for Distributed Learning Using 1-Center and 1-Mean Clustering with Outliers

Byzantine machine learning has garnered considerable attention in light of the unpredictable faults that can occur in large-scale distributed learning systems. The key to secure resilience against Byzantine machines in distributed learning is resilient aggregation mechanisms. Although abundant resilient aggregation rules have been proposed, they are designed in ad-hoc manners, imposing extra barriers on comparing, analyzing, and improving the rules across performance criteria. This paper studies near-optimal aggregation rules using clustering in the presence of outliers. Our outlier-robust clustering approach utilizes geometric properties of the update vectors provided by workers. Our analysis show that constant approximations to the 1-center and 1-mean clustering problems with outliers provide near-optimal resilient aggregators for metric-based criteria, which have been proven to be crucial in the homogeneous and heterogeneous cases respectively. In addition, we discuss two contradicting types of attacks under which no single aggregation rule is guaranteed to improve upon the naive average. Based on the discussion, we propose a two-phase resilient aggregation framework. We run experiments for image classification using a non-convex loss function. The proposed algorithms outperform previously known aggregation rules by a large margin with both homogeneous and heterogeneous data distributions among non-faulty workers. Code and appendix are available at https://github.com/jerry907/AAAI24-RASHB.