AI-based biomarkers can infer molecular features directly from hematoxylin & eosin (H&E) slides, yet most pathology foundation models (PFMs) rely on global patch-level embeddings and overlook cell-level morphology. We present a PFM model, JWTH (Joint-Weighted Token Hierarchy), which integrates large-scale self-supervised pretraining with cell-centric post-tuning and attention pooling to fuse local and global tokens. Across four tasks involving four biomarkers and eight cohorts, JWTH achieves up to 8.3% higher balanced accuracy and 1.2% average improvement over prior PFMs, advancing interpretable and robust AI-based biomarker detection in digital pathology.

Colorectal cancer (CRC) grading is a critical prognostic factor but remains hampered by inter-observer variability and the privacy constraints of multi-institutional data sharing. While deep learning offers a path to automation, centralized training models conflict with data governance regulations and neglect the diagnostic importance of multi-scale analysis. In this work, we propose a scalable, privacy-preserving federated learning (FL) framework for CRC histopathological grading that integrates multi-scale feature learning within a distributed training paradigm. Our approach employs a dual-stream ResNetRS50 backbone to concurrently capture fine-grained nuclear detail and broader tissue-level context. This architecture is integrated into a robust FL system stabilized using FedProx to mitigate client drift across heterogeneous data distributions from multiple hospitals. Extensive evaluation on the CRC-HGD dataset demonstrates that our framework achieves an overall accuracy of 83.5%, outperforming a comparable centralized model (81.6%). Crucially, the system excels in identifying the most aggressive Grade III tumors with a high recall of 87.5%, a key clinical priority to prevent dangerous false negatives. Performance further improves with higher magnification, reaching 88.0% accuracy at 40x. These results validate that our federated multi-scale approach not only preserves patient privacy but also enhances model performance and generalization. The proposed modular pipeline, with built-in preprocessing, checkpointing, and error handling, establishes a foundational step toward deployable, privacy-aware clinical AI for digital pathology.

Pathologists rely on gigapixel whole-slide images (WSIs) to diagnose diseases like cancer, yet current digital pathology tools hinder diagnosis. The immense scale of WSIs, often exceeding 100,000 X 100,000 pixels, clashes with the limited views traditional monitors offer. This mismatch forces constant panning and zooming, increasing pathologist cognitive load, causing diagnostic fatigue, and slowing pathologists' adoption of digital methods. PathVis, our mixed-reality visualization platform for Apple Vision Pro, addresses these challenges. It transforms the pathologist's interaction with data, replacing cumbersome mouse-and-monitor navigation with intuitive exploration using natural hand gestures, eye gaze, and voice commands in an immersive workspace. PathVis integrates AI to enhance diagnosis. An AI-driven search function instantly retrieves and displays the top five similar patient cases side-by-side, improving diagnostic precision and efficiency through rapid comparison. Additionally, a multimodal conversational AI assistant offers real-time image interpretation support and aids collaboration among pathologists across multiple Apple devices. By merging the directness of traditional pathology with advanced mixed-reality visualization and AI, PathVis improves diagnostic workflows, reduces cognitive strain, and makes pathology practice more effective and engaging. The PathVis source code and a demo video are publicly available at: https://github.com/jaiprakash1824/Path_Vis

Quality control of medical images is a critical component of digital pathology, ensuring that diagnostic images meet required standards. A pre-analytical task within this process is the verification of the number of specimen fragments, a process that ensures that the number of fragments on a slide matches the number documented in the macroscopic report. This step is important to ensure that the slides contain the appropriate diagnostic material from the grossing process, thereby guaranteeing the accuracy of subsequent microscopic examination and diagnosis. Traditionally, this assessment is performed manually, requiring significant time and effort while being subject to significant variability due to its subjective nature. To address these challenges, this study explores an automated approach to fragment counting using the YOLOv9 and Vision Transformer models. Our results demonstrate that the automated system achieves a level of performance comparable to expert assessments, offering a reliable and efficient alternative to manual counting. Additionally, we present findings on interobserver variability, showing that the automated approach achieves an accuracy of 86%, which falls within the range of variation observed among experts (82-88%), further supporting its potential for integration into routine pathology workflows.

Deploying digital pathology models across medical centers is challenging due to distribution shifts. Recent advances in domain generalization improve model transferability in terms of aggregated performance measured by the Area Under Curve (AUC). However, clinical regulations often require to control the transferability of other metrics, such as prescribed sensitivity levels. We introduce a novel approach to control the sensitivity of whole slide image (WSI) classification models, based on optimal transport and Multiple Instance Learning (MIL). Validated across multiple cohorts and tasks, our method enables robust sensitivity control with only a handful of calibration samples, providing a practical solution for reliable deployment of computational pathology systems.

Inflammation of the umbilical cord can be seen as a result of ascending intrauterine infection or other inflammatory stimuli. Acute fetal inflammatory response (FIR) is characterized by infiltration of the umbilical cord by fetal neutrophils, and can be associated with neonatal sepsis or fetal inflammatory response syndrome. Recent advances in deep learning in digital pathology have demonstrated favorable performance across a wide range of clinical tasks, such as diagnosis and prognosis. In this study we classified FIR from whole slide images (WSI). We digitized 4100 histological slides of umbilical cord stained with hematoxylin and eosin(H&E) and extracted placental diagnoses from the electronic health record. We build models using attention-based whole slide learning models. We compared strategies between features extracted by a model (ConvNeXtXLarge) pretrained on non-medical images (ImageNet), and one pretrained using histopathology images (UNI). We trained multiple iterations of each model and combined them into an ensemble. The predictions from the ensemble of models trained using UNI achieved an overall balanced accuracy of 0.836 on the test dataset. In comparison, the ensembled predictions using ConvNeXtXLarge had a lower balanced accuracy of 0.7209. Heatmaps generated from top accuracy model appropriately highlighted arteritis in cases of FIR 2. In FIR 1, the highest performing model assigned high attention to areas of activated-appearing stroma in Wharton's Jelly. However, other high-performing models assigned attention to umbilical vessels. We developed models for diagnosis of FIR from placental histology images, helping reduce interobserver variability among pathologists. Future work may examine the utility of these models for identifying infants at risk of systemic inflammatory response or early onset neonatal sepsis.

In the evolving field of digital pathology, Whole Slide Imaging (WSI) has emerged as a transformative technology, enabling the digitization of histopathological slides at gigapixel resolution. This advancement has not only facilitated remote diagnostics and educational opportunities but also opened new avenues for quantitative image analysis [1, 2]. Despite its potential, the sheer size and complexity of WSIs pose significant computational challenges, limiting the practicality of large-scale analysis and the application of advanced machine learning techniques [3, 4]. Whole slide imaging (WSI) represents a significant breakthrough in digital pathology, enabling the digitization of histological slides at high resolutions. This advancement allows for improved visualization, analysis, and management of tissue samples, essential for accurate disease diagnosis and research. However, the sheer size and complexity of WSIs pose unique challenges in image processing and analysis, necessitating innovative approaches for efficient and effective feature extraction and classification. Traditional methods for analyzing WSIs often rely on supervised learning techniques, which require extensive annotated datasets prepared by expert pathologists. This process is not only time-consuming but also prone to variability due to inter-observer differences.

The advancement of digital pathology, particularly through computational analysis of whole slide images (WSI), is poised to significantly enhance diagnostic precision and efficiency. However, the large size and complexity of WSIs make it difficult to analyze and classify them using computers. This study introduces a novel method for WSI classification by automating the identification and examination of the most informative patches, thus eliminating the need to process the entire slide. Our method involves two-stages: firstly, it extracts only a few patches from the WSIs based on their pathological significance; and secondly, it employs Fisher vectors (FVs) for representing features extracted from these patches, which is known for its robustness in capturing fine-grained details. This approach not only accentuates key pathological features within the WSI representation but also significantly reduces computational overhead, thus making the process more efficient and scalable. We have rigorously evaluated the proposed method across multiple datasets to benchmark its performance against comprehensive WSI analysis and contemporary weakly-supervised learning methodologies. The empirical results indicate that our focused analysis of select patches, combined with Fisher vector representation, not only aligns with, but at times surpasses, the classification accuracy of standard practices. Moreover, this strategy notably diminishes computational load and resource expenditure, thereby establishing an efficient and precise framework for WSI analysis in the realm of digital pathology.

Vision-language supervision has made remarkable strides in learning visual representations from textual guidance. In digital pathology, vision-language models (VLM), pre-trained on curated datasets of histological image-captions, have been adapted to downstream tasks, such as region of interest classification. Zero-shot transfer for slide-level prediction has been formulated by MI-Zero [1], but it exhibits high variability depending on the textual prompts. Inspired by prototypical learning, we propose MI-VisionShot, a training-free adaptation method on top of VLMs to predict slide-level labels in few-shot learning scenarios. Our framework takes advantage of the excellent representation learning of VLM to create prototype-based classifiers under a multipleinstance setting by retrieving the most discriminative patches within each slide. Experimentation through different settings shows the ability of MI-VisionShot to surpass zero-shot transfer with lower variability, even in low-shot scenarios.

Digital pathology is revolutionizing the field of pathology by enabling the digitization, storage, and analysis of tissue samples as whole slide images (WSIs). WSIs are gigapixel files that capture the intricate details of tissue samples, providing a rich source of information for diagnostic and research purposes. However, due to their enormous size, representing these images as one compact vector is essential for many computational pathology tasks, such as search and retrieval, to ensure efficiency and scalability. Most current methods are "patch-oriented," meaning they divide WSIs into smaller patches for processing, which prevents a holistic analysis of the entire slide. Additionally, the necessity for compact representation is driven by the expensive high-performance storage required for WSIs. Not all hospitals have access to such extensive storage solutions, leading to potential disparities in healthcare quality and accessibility. This paper provides an overview of existing set-based approaches to single-vector WSI representation, highlighting the innovations that allow for more efficient and effective use of these complex images in digital pathology, thus addressing both computational challenges and storage limitations.