Continual Multiple Instance Learning with Enhanced Localization for Histopathological Whole Slide Image Analysis

Multiple instance learning (MIL) significantly reduced annotation costs via bag-level weak labels for large-scale images, such as histopathological whole slide images (WSIs). However, its adaptability to continual tasks with minimal forgetting has been rarely explored, especially on instance classification for localization. Weakly incremental learning for semantic segmentation has been studied for continual localization, but it focused on natural images, leveraging global relationships among hundreds of small patches (e.g., $16 \times 16$) using pre-trained models. This approach seems infeasible for MIL localization due to enormous amounts ($\sim 10^5$) of large patches (e.g., $256 \times 256$) and no available global relationships such as cancer cells. To address these challenges, we propose Continual Multiple Instance Learning with Enhanced Localization (CoMEL), an MIL framework for both localization and adaptability with minimal forgetting. CoMEL consists of (1) Grouped Double Attention Transformer (GDAT) for efficient instance encoding, (2) Bag Prototypes-based Pseudo-Labeling (BPPL) for reliable instance pseudo-labeling, and (3) Orthogonal Weighted Low-Rank Adaptation (OWLoRA) to mitigate forgetting in both bag and instance classification. Extensive experiments on three public WSI datasets demonstrate superior performance of CoMEL, outperforming the prior arts by up to $11.00\%$ in bag-level accuracy and up to $23.4\%$ in localization accuracy under the continual MIL setup.

Evaluating Cell Type Inference in Vision Language Models Under Varying Visual Context

Vision-Language Models (VLMs) have rapidly advanced alongside Large Language Models (LLMs). This study evaluates the capabilities of prominent generative VLMs, such as GPT-4.1 and Gemini 2.5 Pro, accessed via APIs, for histopathology image classification tasks, including cell typing. Using diverse datasets from public and private sources, we apply zero-shot and one-shot prompting methods to assess VLM performance, comparing them against custom-trained Convolutional Neural Networks (CNNs). Our findings demonstrate that while one-shot prompting significantly improves VLM performance over zero-shot ($p \approx 1.005 \times 10^{-5}$ based on Kappa scores), these general-purpose VLMs currently underperform supervised CNNs on most tasks. This work underscores both the promise and limitations of applying current VLMs to specialized domains like pathology via in-context learning. All code and instructions for reproducing the study can be accessed from the repository https://www.github.com/a12dongithub/VLMCCE.

FedWSIDD: Federated Whole Slide Image Classification via Dataset Distillation

Federated learning (FL) has emerged as a promising approach for collaborative medical image analysis, enabling multiple institutions to build robust predictive models while preserving sensitive patient data. In the context of Whole Slide Image (WSI) classification, FL faces significant challenges, including heterogeneous computational resources across participating medical institutes and privacy concerns. To address these challenges, we propose FedWSIDD, a novel FL paradigm that leverages dataset distillation (DD) to learn and transmit synthetic slides. On the server side, FedWSIDD aggregates synthetic slides from participating centres and distributes them across all centres. On the client side, we introduce a novel DD algorithm tailored to histopathology datasets which incorporates stain normalisation into the distillation process to generate a compact set of highly informative synthetic slides. These synthetic slides, rather than model parameters, are transmitted to the server. After communication, the received synthetic slides are combined with original slides for local tasks. Extensive experiments on multiple WSI classification tasks, including CAMELYON16 and CAMELYON17, demonstrate that FedWSIDD offers flexibility for heterogeneous local models, enhances local WSI classification performance, and preserves patient privacy. This makes it a highly effective solution for complex WSI classification tasks. The code is available at FedWSIDD.

Test-Time-Scaling for Zero-Shot Diagnosis with Visual-Language Reasoning

As a cornerstone of patient care, clinical decision-making significantly influences patient outcomes and can be enhanced by large language models (LLMs). Although LLMs have demonstrated remarkable performance, their application to visual question answering in medical imaging, particularly for reasoning-based diagnosis, remains largely unexplored. Furthermore, supervised fine-tuning for reasoning tasks is largely impractical due to limited data availability and high annotation costs. In this work, we introduce a zero-shot framework for reliable medical image diagnosis that enhances the reasoning capabilities of LLMs in clinical settings through test-time scaling. Given a medical image and a textual prompt, a vision-language model processes a medical image along with a corresponding textual prompt to generate multiple descriptions or interpretations of visual features. These interpretations are then fed to an LLM, where a test-time scaling strategy consolidates multiple candidate outputs into a reliable final diagnosis. We evaluate our approach across various medical imaging modalities -- including radiology, ophthalmology, and histopathology -- and demonstrate that the proposed test-time scaling strategy enhances diagnostic accuracy for both our and baseline methods. Additionally, we provide an empirical analysis showing that the proposed approach, which allows unbiased prompting in the first stage, improves the reliability of LLM-generated diagnoses and enhances classification accuracy.

DIsoN: Decentralized Isolation Networks for Out-of-Distribution Detection in Medical Imaging

Safe deployment of machine learning (ML) models in safety-critical domains such as medical imaging requires detecting inputs with characteristics not seen during training, known as out-of-distribution (OOD) detection, to prevent unreliable predictions. Effective OOD detection after deployment could benefit from access to the training data, enabling direct comparison between test samples and the training data distribution to identify differences. State-of-the-art OOD detection methods, however, either discard training data after deployment or assume that test samples and training data are centrally stored together, an assumption that rarely holds in real-world settings. This is because shipping training data with the deployed model is usually impossible due to the size of training databases, as well as proprietary or privacy constraints. We introduce the Isolation Network, an OOD detection framework that quantifies the difficulty of separating a target test sample from the training data by solving a binary classification task. We then propose Decentralized Isolation Networks (DIsoN), which enables the comparison of training and test data when data-sharing is impossible, by exchanging only model parameters between the remote computational nodes of training and deployment. We further extend DIsoN with class-conditioning, comparing a target sample solely with training data of its predicted class. We evaluate DIsoN on four medical imaging datasets (dermatology, chest X-ray, breast ultrasound, histopathology) across 12 OOD detection tasks. DIsoN performs favorably against existing methods while respecting data-privacy. This decentralized OOD detection framework opens the way for a new type of service that ML developers could provide along with their models: providing remote, secure utilization of their training data for OOD detection services. Code will be available upon acceptance at: *****

Multi-instance Learning as Downstream Task of Self-Supervised Learning-based Pre-trained Model

In deep multi-instance learning, the number of applicable instances depends on the data set. In histopathology images, deep learning multi-instance learners usually assume there are hundreds to thousands instances in a bag. However, when the number of instances in a bag increases to 256 in brain hematoma CT, learning becomes extremely difficult. In this paper, we address this drawback. To overcome this problem, we propose using a pre-trained model with self-supervised learning for the multi-instance learner as a downstream task. With this method, even when the original target task suffers from the spurious correlation problem, we show improvements of 5% to 13% in accuracy and 40% to 55% in the F1 measure for the hypodensity marker classification of brain hematoma CT.

DCS-ST for Classification of Breast Cancer Histopathology Images with Limited Annotations

Deep learning methods have shown promise in classifying breast cancer histopathology images, but their performance often declines with limited annotated data, a critical challenge in medical imaging due to the high cost and expertise required for annotations.

An Artificial Intelligence Model for Early Stage Breast Cancer Detection from Biopsy Images

Accurate identification of breast cancer types plays a critical role in guiding treatment decisions and improving patient outcomes. This paper presents an artificial intelligence enabled tool designed to aid in the identification of breast cancer types using histopathological biopsy images. Traditionally additional tests have to be done on women who are detected with breast cancer to find out the types of cancer it is to give the necessary cure. Those tests are not only invasive but also delay the initiation of treatment and increase patient burden. The proposed model utilizes a convolutional neural network (CNN) architecture to distinguish between benign and malignant tissues as well as accurate subclassification of breast cancer types. By preprocessing the images to reduce noise and enhance features, the model achieves reliable levels of classification performance. Experimental results on such datasets demonstrate the model's effectiveness, outperforming several existing solutions in terms of accuracy, precision, recall, and F1-score. The study emphasizes the potential of deep learning techniques in clinical diagnostics and offers a promising tool to assist pathologists in breast cancer classification.

Graph Mamba for Efficient Whole Slide Image Understanding

Whole Slide Images (WSIs) in histopathology present a significant challenge for large-scale medical image analysis due to their high resolution, large size, and complex tile relationships. Existing Multiple Instance Learning (MIL) methods, such as Graph Neural Networks (GNNs) and Transformer-based models, face limitations in scalability and computational cost. To bridge this gap, we propose the WSI-GMamba framework, which synergistically combines the relational modeling strengths of GNNs with the efficiency of Mamba, the State Space Model designed for sequence learning. The proposed GMamba block integrates Message Passing, Graph Scanning & Flattening, and feature aggregation via a Bidirectional State Space Model (Bi-SSM), achieving Transformer-level performance with 7* fewer FLOPs. By leveraging the complementary strengths of lightweight GNNs and Mamba, the WSI-GMamba framework delivers a scalable solution for large-scale WSI analysis, offering both high accuracy and computational efficiency for slide-level classification.

Breast Cancer Classification in Deep Ultraviolet Fluorescence Images Using a Patch-Level Vision Transformer Framework

Breast-conserving surgery (BCS) aims to completely remove malignant lesions while maximizing healthy tissue preservation. Intraoperative margin assessment is essential to achieve a balance between thorough cancer resection and tissue conservation. A deep ultraviolet fluorescence scanning microscope (DUV-FSM) enables rapid acquisition of whole surface images (WSIs) for excised tissue, providing contrast between malignant and normal tissues. However, breast cancer classification with DUV WSIs is challenged by high resolutions and complex histopathological features. This study introduces a DUV WSI classification framework using a patch-level vision transformer (ViT) model, capturing local and global features. Grad-CAM++ saliency weighting highlights relevant spatial regions, enhances result interpretability, and improves diagnostic accuracy for benign and malignant tissue classification. A comprehensive 5-fold cross-validation demonstrates the proposed approach significantly outperforms conventional deep learning methods, achieving a classification accuracy of 98.33%.