Before that, it is crucial to develop benchmarks to evaluate L VLMs' effectiveness in various medical applications.

Whole slide image (WSI) analysis is gaining prominence within the medical imaging field.

The development of accessible screening tools for early cancer detection in dogs represents a significant challenge in veterinary medicine. Routine laboratory data offer a promising, low-cost source for such tools, but their utility is hampered by the non-specificity of individual biomarkers and the severe class imbalance inherent in screening populations. This study assesses the feasibility of cancer risk classification using the Golden Retriever Lifetime Study (GRLS) cohort under real-world constraints, including the grouping of diverse cancer types and the inclusion of post-diagnosis samples. A comprehensive benchmark evaluation was conducted, systematically comparing 126 analytical pipelines that comprised various machine learning models, feature selection methods, and data balancing techniques. Data were partitioned at the patient level to prevent leakage. The optimal model, a Logistic Regression classifier with class weighting and recursive feature elimination, demonstrated moderate ranking ability (AUROC = 0.815; 95% CI: 0.793-0.836) but poor clinical classification performance (F1-score = 0.25, Positive Predictive Value = 0.15). While a high Negative Predictive Value (0.98) was achieved, insufficient recall (0.79) precludes its use as a reliable rule-out test. Interpretability analysis with SHapley Additive exPlanations (SHAP) revealed that predictions were driven by non-specific features like age and markers of inflammation and anemia. It is concluded that while a statistically detectable cancer signal exists in routine lab data, it is too weak and confounded for clinically reliable discrimination from normal aging or other inflammatory conditions. This work establishes a critical performance ceiling for this data modality in isolation and underscores that meaningful progress in computational veterinary oncology will require integration of multi-modal data sources.

Complex biological networks are fundamental to biomedical science, capturing interactions among molecules, cells, genes, and tissues. Deciphering these networks is critical for understanding health and disease, yet their scale and complexity represent a daunting challenge for current computational methods. Traditional biological network analysis methods, including deep learning approaches, while powerful, face inherent challenges such as limited scalability, oversmoothing long-range dependencies, difficulty in multimodal integration, expressivity bounds, and poor interpretability. We present Graph2Image, a framework that transforms large biological networks into sets of two-dimensional images by spatially arranging representative network nodes on a 2D grid. This transformation decouples the nodes as images, enabling the use of convolutional neural networks (CNNs) with global receptive fields and multi-scale pyramids, thus overcoming limitations of existing biological network analysis methods in scalability, memory efficiency, and long-range context capture. Graph2Image also facilitates seamless integration with other imaging and omics modalities and enhances interpretability through direct visualization of node-associated images. When applied to several large-scale biological network datasets, Graph2Image improved classification accuracy by up to 67.2% over existing methods and provided interpretable visualizations that revealed biologically coherent patterns. It also allows analysis of very large biological networks (nodes > 1 billion) on a personal computer. Graph2Image thus provides a scalable, interpretable, and multimodal-ready approach for biological network analysis, offering new opportunities for disease diagnosis and the study of complex biological systems.

Deciphering tumor microenvironment from Whole Slide Images (WSIs) is intriguing as it is key to cancer diagnosis, prognosis and treatment response. While these gigapixel images on one hand offer a comprehensive portrait of cancer, on the other hand, the extremely large size, as much as more than 10 billion pixels, make it challenging and time-consuming to navigate to corresponding regions to support diverse clinical inspection. Inspired by pathologists who conducted navigation on WSIs with a combination of sampling, reasoning and self-reflection, we proposed "PathReasoning", a multi-modal reasoning agent that iteratively navigates across WSIs through multiple rounds of reasoning and refinements. Specifically, starting with randomly sampled candidate regions, PathReasoning reviews current selections with self-reflection, reasoning over the correspondence between visual observations and clinical questions, and concludes by proposing new regions to explore. Across rounds, PathReasoning builds a reasoning chain that gradually directs attention to diagnostically relevant areas. PathReasoning turns each whole slide into a sequence of question-guided views, allowing the model to efficiently find informative ROIs within a fixed number of steps, without the need for dense pixel-level annotations. PathReasoning can substantially outperform strong ROI-selection approaches by 6.7% and 3.1% of AUROC on subtyping and longitudinal analysis tasks. The high-quality ROIs further support accurate report generation on breast cancer, significantly outperforming the standard GPT-4o by 10% in accuracy. PathReasoning prioritizes question-specific regions and constructs interpretable reasoning chains, supporting efficient slide review, consistent diagnostic interpretations, comprehensive reporting, and evidence traceability in digital pathology.

We introduce VoxTell, a vision-language model for text-prompted volumetric medical image segmentation. It maps free-form descriptions, from single words to full clinical sentences, to 3D masks. Trained on 62K+ CT, MRI, and PET volumes spanning over 1K anatomical and pathological classes, VoxTell uses multi-stage vision-language fusion across decoder layers to align textual and visual features at multiple scales. It achieves state-of-the-art zero-shot performance across modalities on unseen datasets, excelling on familiar concepts while generalizing to related unseen classes. Extensive experiments further demonstrate strong cross-modality transfer, robustness to linguistic variations and clinical language, as well as accurate instance-specific segmentation from real-world text. Code is available at: https://www.github.com/MIC-DKFZ/VoxTell

In computational pathology, the gigapixel scale of Whole-Slide Images (WSIs) necessitates their division into thousands of smaller patches. Analyzing these high-dimensional patch embeddings is computationally expensive and risks diluting key diagnostic signals with many uninformative patches. Existing patch selection methods often rely on random sampling or simple clustering heuristics and typically fail to explicitly manage the crucial trade-off between the number of selected patches and the accuracy of the resulting slide representation. To address this gap, we propose EvoPS (Evolutionary Patch Selection), a novel framework that formulates patch selection as a multi-objective optimization problem and leverages an evolutionary search to simultaneously minimize the number of selected patch embeddings and maximize the performance of a downstream similarity search task, generating a Pareto front of optimal trade-off solutions. We validated our framework across four major cancer cohorts from The Cancer Genome Atlas (TCGA) using five pretrained deep learning models to generate patch embeddings, including both supervised CNNs and large self-supervised foundation models. The results demonstrate that EvoPS can reduce the required number of training patch embeddings by over 90% while consistently maintaining or even improving the final classification F1-score compared to a baseline that uses all available patches' embeddings selected through a standard extraction pipeline. The EvoPS framework provides a robust and principled method for creating efficient, accurate, and interpretable WSI representations, empowering users to select an optimal balance between computational cost and diagnostic performance.

Recent rapid progress in the field of computational pathology has been enabled by foundation models. These models are beginning to move beyond encoding image patches towards whole-slide understanding but their clinical utility remains limited. In this work, we present PRISM2, a multimodal slide-level foundation model trained on data from 700,000 diagnostic specimen-report pairs, the largest vision (2.3 million whole slide images) and language (14M question-answer pairs) histopathology dataset to date. By learning through clinical-dialogue supervision, PRISM2 aligns histomorphologic features with the language of diagnostic reasoning, producing slide-level representations that support both direct diagnostic question-answering and transferable embeddings for downstream tasks. Without additional training, PRISM2 matches or exceeds the cancer-detection performance of clinical-grade products. This is observed without loss of generality on other tasks, where PRISM2 achieves top performance. Finally, using survival prediction as the example, we show that task-specific finetuning with a large dataset can outperform task-specific models, further improving performance. These results demonstrate how language-supervised pretraining provides a scalable, clinically grounded signal for learning generalizable pathology representations, bridging human diagnostic reasoning and foundation-model performance.