Qixiang Zhang, Yi Li, Tianqi Xiang +4eess.IV cs.CV q-bio.QM
Whole slide image analysis is commonly formulated as multiple instance learning (MIL), where instance features are contextually updated and aggregated into a slide representation, a process we term slide encoding dynamics. Recently, selective state-space models (SSM) have emerged as promising MIL architectures due to their long-sequence modeling capability and linear complexity. However, existing SSM-based MIL methods rely solely on visual features during MIL. Meanwhile, in large-scale WSIs, where sparse diagnostically decisive regions are surrounded by abundant irrelevant information, such purely vision-driven selective dynamics can misallocate state updates and readouts, causing the evolving SSM state to accumulate task-irrelevant evidence and dilute critical diagnostic cues over long scan trajectories. In this work, we propose the Knowledge-Aware Hidden-State Modulation architecture (KHiM-Mamba), which innovatively regulates Mamba's core selective state-space mechanism with explicit knowledge priors, steering slide encoding dynamics toward diagnostically meaningful evidence accumulation. Specifically, we redesign the original SSM layer to perform knowledge modulation operations during the evolution of hidden states, thereby guiding what visual evidence is accumulated and retrieved from the hidden state at each encoding step. Furthermore, we additionally introduce a local-adaptive vocabulary retrieval module that uses large language models to assign each patch fine-grained, tissue-specific semantic descriptions, enabling precise modulation across diverse tasks. Experiments on 11 public benchmarks across 4 tasks show that KHiM-Mamba consistently achieves state-of-the-art performance.
Multiple instance learning (MIL) is widely used for weakly supervised whole slide image (WSI) analysis. However, under long-tailed distributions, MIL-based WSI analysis faces a nested dual long-tail: an inter-slide class long tail and an intra-slide long tail of instance-level discriminative evidence. The two long tails are coupled: tail classes have few training slides, while their limited diagnostic evidence is concentrated in a few patches and obscured by abundant within-bag redundancy. This coupling biases models toward head classes and degrades rare-class recognition. To address this, we propose DeCo-MIL for long-tailed WSI analysis, which jointly alleviates the nested dual long-tail through frequency-debiased counterfactual reasoning. For the inner long tail, DeCo-MIL clusters patches into tissue-morphology anchors, replaces each anchor with its matched normal prototype to perform a counterfactual intervention, and estimates its counterfactual contribution to the ground-truth class using class-frequency-corrected predictions. These contributions guide redundancy masking to preserve scarce discriminative instances. For the outer long tail, DeCo-MIL constructs anchor-stratified pseudo-bags from redundancy-reduced bags and combines tail-aware oversampling with consistency regularization, increasing effective supervision for tail classes while preserving tissue-morphology composition. Extensive experiments on three long-tailed WSI benchmarks demonstrate that DeCo-MIL achieves state-of-the-art performance in both tail-class recognition and overall classification.
Each WSI slide contains thousands of candidate tissue patches, while supervision is usually available only at slide level. Existing bag-construction strategies like Uniform extraction and handcrafted heuristics do not control redundancy while attention-based multiple-instance models couple patch importance to a particular downstream classifier, and coreset methods optimise embedding-space coverage without modelling task-relevant patch quality. We introduce InfoDPP-PAC, a principled patch-selection framework that combines teacher-seeded Gaussian process relevance modelling, determinantal log-determinant diversity,submodular greedy optimisation, and a concentration-based adaptive stopping rule. The main theoretical result shows that the log-determinant diversity term used in DPP-style selection is the Gaussian process mutual information between a selected subset and the latent relevance function. We further derive a PAC-style certificate for residual information gain, allowing the number of retained patches to vary by slide rather than being fixed a priori. The empirical study evaluates whether the selected subset is diverse, spatially and morphologically covering, non-redundant, and enriched for the teacher-derived relevance signal. It does not claim end-to-end diagnostic improvement after retraining a downstream MIL model. On 202 HISTAI gastrointestinal whole-slide images, the adaptive rule uses 83.7% fewer patches on average than a fixed full budget while retaining 97.9% of full-budget composite selection quality. At a matched budget, InfoDPP-PAC achieves the highest mean teacher-derived relevance score among fourteen baselines, with diversity and composite scores close to the strongest coreset methods. The results support InfoDPP-PAC as a controlled quality-diversity-cardinality selection framework, rather than as a downstream clinical predictor.
Chaeyeon Lee, Khang Nguyen Quoc, Jinsol Song +3cs.CV
Whole slide image (WSI) analysis is central to computational pathology, with multiple instance learning (MIL) emerging as the standard pipeline for slide-level diagnosis. However, conventional approaches formulate WSI diagnosis as a flat classification task over discrete labels, contradicting the inherently hierarchical, coarse-to-fine nature of clinical reasoning. Although recent hierarchical classifiers and vision-language models (VLMs) have sought to address this structural gap, they either fail to capture semantic continuity between related diagnoses or suffer from unconstrained text generation that produces taxonomic hallucinations and parent-child label violations. To address these limitations, we propose TaxoMIL, a taxonomy-constrained framework that reformulates WSI diagnosis as a multi-granularity text generation task. TaxoMIL utilizes a dual-head Transformer decoder to generate coarse- and fine-level diagnostic text, and introduces taxonomy-guided objectives that explicitly structure the label embedding space and strictly ground slide-level visual representations within the clinical taxonomy. Extensive experiments across three diverse WSI datasets demonstrate that TaxoMIL consistently outperforms state-of-the-art MIL classifiers and VLM-based generative methods, yielding accurate and hierarchy-aware diagnostic predictions. The code is released at https://github.com/QuIIL/TaxoMIL