Lisa A. Boardman

Saghir Alfasly, Peyman Nejat, Sobhan Hemati et al.

Recently, several studies have reported on the fine-tuning of foundation models for image-text modeling in the field of medicine, utilizing images from online data sources such as Twitter and PubMed. Foundation models are large, deep artificial neural networks capable of learning the context of a specific domain through training on exceptionally extensive datasets. Through validation, we have observed that the representations generated by such models exhibit inferior performance in retrieval tasks within digital pathology when compared to those generated by significantly smaller, conventional deep networks.

Isaiah Lahr, Saghir Alfasly, Peyman Nejat et al.

Searching for similar images in archives of histology and histopathology images is a crucial task that may aid in patient matching for various purposes, ranging from triaging and diagnosis to prognosis and prediction. Whole slide images (WSIs) are highly detailed digital representations of tissue specimens mounted on glass slides. Matching WSI to WSI can serve as the critical method for patient matching. In this paper, we report extensive analysis and validation of four search methods bag of visual words (BoVW), Yottixel, SISH, RetCCL, and some of their potential variants. We analyze their algorithms and structures and assess their performance. For this evaluation, we utilized four internal datasets ($1269$ patients) and three public datasets ($1207$ patients), totaling more than $200,000$ patches from $38$ different classes/subtypes across five primary sites. Certain search engines, for example, BoVW, exhibit notable efficiency and speed but suffer from low accuracy. Conversely, search engines like Yottixel demonstrate efficiency and speed, providing moderately accurate results. Recent proposals, including SISH, display inefficiency and yield inconsistent outcomes, while alternatives like RetCCL prove inadequate in both accuracy and efficiency. Further research is imperative to address the dual aspects of accuracy and minimal storage requirements in histopathological image search.

Peter Neidlinger, Tim Lenz, Sebastian Foersch et al.

Artificial intelligence (AI) has transformed digital pathology by enabling biomarker prediction from high-resolution whole slide images (WSIs). However, current methods are computationally inefficient, processing thousands of redundant tiles per WSI and requiring complex aggregator models. We introduce EAGLE (Efficient Approach for Guided Local Examination), a deep learning framework that emulates pathologists by selectively analyzing informative regions. EAGLE incorporates two foundation models: CHIEF for efficient tile selection and Virchow2 for extracting high-quality features. Benchmarking was conducted against leading slide- and tile-level foundation models across 31 tasks from four cancer types, spanning morphology, biomarker prediction and prognosis. EAGLE outperformed state-of-the-art foundation models by up to 23% and achieved the highest AUROC overall. It processed a slide in 2.27 seconds, reducing computational time by more than 99% compared to existing models. This efficiency enables real-time workflows, allows pathologists to validate all tiles which are used by the model during analysis, and eliminates dependence on high-performance computing, making AI-powered pathology more accessible. By reliably identifying meaningful regions and minimizing artifacts, EAGLE provides robust and interpretable outputs, supporting rapid slide searches, integration into multi-omics pipelines and emerging clinical foundation models.