Hong Bu

Wenchuan Zhang, Penghao Zhang, Jingru Guo et al.

Recent advances in vision language models (VLMs) have enabled broad progress in the general medical field. However, pathology still remains a more challenging subdomain, with current pathology specific VLMs exhibiting limitations in both diagnostic accuracy and reasoning plausibility. Such shortcomings are largely attributable to the nature of current pathology datasets, which are primarily composed of image description pairs that lack the depth and structured diagnostic paradigms employed by real world pathologists. In this study, we leverage pathology textbooks and real world pathology experts to construct high-quality, reasoning-oriented datasets. Building on this, we introduce Patho-R1, a multimodal RL-based pathology Reasoner, trained through a three-stage pipeline: (1) continued pretraining on 3.5 million image-text pairs for knowledge infusion; (2) supervised fine-tuning on 500k high-quality Chain-of-Thought samples for reasoning incentivizing; (3) reinforcement learning using Group Relative Policy Optimization and Decoupled Clip and Dynamic sAmpling Policy Optimization strategies for multimodal reasoning quality refinement. To further assess the alignment quality of our dataset, we propose Patho-CLIP, trained on the same figure-caption corpus used for continued pretraining. Comprehensive experimental results demonstrate that both Patho-CLIP and Patho-R1 achieve robust performance across a wide range of pathology-related tasks, including zero-shot classification, cross-modal retrieval, Visual Question Answering, and Multiple Choice Question. Our project is available at the Patho-R1 repository: https://github.com/Wenchuan-Zhang/Patho-R1.

Yongquan Yang, Fengling Li, Yani Wei et al.

In breast cancer, neoadjuvant chemotherapy (NAC) provides a standard treatment option for patients who have locally advanced cancer and some large operable tumors. A patient will have better prognosis when he has achieved a pathological complete response (pCR) with the treatment of NAC. There has been a trend to directly predict pCR to NAC from histological images based on deep learning (DL). However, the DL-based predictive models numerically have better performances in internal validation than in external validation. In this paper, we aim to alleviate this situation with an intrinsic approach. We propose an experts' cognition-driven ensemble deep learning (ECDEDL) approach. Taking the cognition of both pathology and artificial intelligence experts into consideration to improve the generalization of the predictive model to the external validation, ECDEDL can intrinsically approximate the working paradigm of a human being which will refer to his various working experiences to make decisions. ECDEDL was validated with 695 WSIs collected from the same center as the primary dataset to develop the predictive model and perform the internal validation, and was also validated with 340 WSIs collected from other three centers as the external dataset to perform the external validation. In external validation, ECDEDL improves the AUCs of pCR prediction from 61.52(59.80-63.26) to 67.75(66.74-68.80) and the Accuracies of pCR prediction from 56.09(49.39-62.79) to 71.01(69.44-72.58). ECDEDL was quite effective for external validation of predicting pCR to NAC from histological images in breast cancer, numerically approximating the internal validation.

Yongquan Yang, Jie Chen, Yani Wei et al.

Precise segmentation of residual tumor in breast cancer (PSRTBC) after neoadjuvant chemotherapy is a fundamental key technique in the treatment process of breast cancer. However, achieving PSRTBC is still a challenge, since the breast cancer tissue and tumor cells commonly have complex and varied morphological changes after neoadjuvant chemotherapy, which inevitably increases the difficulty to produce a predictive model that has good generalization with usual supervised learning (SL). To alleviate this situation, in this paper, we propose an experts' cognition-driven safe noisy labels learning (ECDSNLL) approach. In the concept of safe noisy labels learning, which is a typical type of safe weakly supervised learning, ECDSNLL is constructed by integrating the pathology experts' cognition about identifying residual tumor in breast cancer and the artificial intelligence experts' cognition about data modeling with provided data basis. Experimental results show that, compared with usual SL, ECDSNLL can significantly improve the lower bound of a number of UNet variants with 2.42% and 4.1% respectively in recall and fIoU for PSRTBC, while being able to achieve improvements in mean value and upper bound as well.

Wenchuan Zhang, Jingru Guo, Hengzhe Zhang et al.

Although Vision Language Models (VLMs) have shown strong generalization in medical imaging, pathology presents unique challenges due to ultra-high resolution, complex tissue structures, and nuanced clinical semantics. These factors make pathology VLMs prone to hallucinations, i.e., generating outputs inconsistent with visual evidence, which undermines clinical trust. Existing RAG approaches in this domain largely depend on text-based knowledge bases, limiting their ability to leverage diagnostic visual cues. To address this, we propose Patho-AgenticRAG, a multimodal RAG framework with a database built on page-level embeddings from authoritative pathology textbooks. Unlike traditional text-only retrieval systems, it supports joint text-image search, enabling direct retrieval of textbook pages that contain both the queried text and relevant visual cues, thus avoiding the loss of critical image-based information. Patho-AgenticRAG also supports reasoning, task decomposition, and multi-turn search interactions, improving accuracy in complex diagnostic scenarios. Experiments show that Patho-AgenticRAG significantly outperforms existing multimodal models in complex pathology tasks like multiple-choice diagnosis and visual question answering. Our project is available at the Patho-AgenticRAG repository: https://github.com/Wenchuan-Zhang/Patho-AgenticRAG.

Yongquan Yang, Hong Bu

The logical assessment formula (LAF) is a new theory proposed for evaluations with inaccurate ground-truth labels (IAGTLs) to assess the predictive models for artificial intelligence applications. However, the practicability of LAF for evaluations with IAGTLs has not yet been validated in real-world practice. In this paper, we applied LAF to two tasks of tumour segmentation for breast cancer (TSfBC) in medical histopathology whole slide image analysis (MHWSIA) for evaluations with IAGTLs. Experimental results and analysis show that the LAF-based evaluations with IAGTLs were unable to confidently act like usual evaluations with accurate ground-truth labels on the one easier task of TSfBC while being able to reasonably act like usual evaluations with AGTLs on the other more difficult task of TSfBC. These results and analysis reflect the potential of LAF applied to MHWSIA for evaluations with IAGTLs. This paper presents the first practical validation of LAF for evaluations with IAGTLs in a real-world application.

Bao Li, Zhenyu Liu, Lizhi Shao et al.

Directly predicting human epidermal growth factor receptor 2 (HER2) status from widely available hematoxylin and eosin (HE)-stained whole slide images (WSIs) can reduce technical costs and expedite treatment selection. Accurately predicting HER2 requires large collections of multi-site WSIs. Federated learning enables collaborative training of these WSIs without gigabyte-size WSIs transportation and data privacy concerns. However, federated learning encounters challenges in addressing label imbalance in multi-site WSIs from the real world. Moreover, existing WSI classification methods cannot simultaneously exploit local context information and long-range dependencies in the site-end feature representation of federated learning. To address these issues, we present a point transformer with federated learning for multi-site HER2 status prediction from HE-stained WSIs. Our approach incorporates two novel designs. We propose a dynamic label distribution strategy and an auxiliary classifier, which helps to establish a well-initialized model and mitigate label distribution variations across sites. Additionally, we propose a farthest cosine sampling based on cosine distance. It can sample the most distinctive features and capture the long-range dependencies. Extensive experiments and analysis show that our method achieves state-of-the-art performance at four sites with a total of 2687 WSIs. Furthermore, we demonstrate that our model can generalize to two unseen sites with 229 WSIs.

Chen Shu, Boyu Fu, Yiman Li et al.

Multiple Instance Learning is the predominant method for Whole Slide Image classification in digital pathology, enabling the use of slide-level labels to supervise model training. Although MIL eliminates the tedious fine-grained annotation process for supervised learning, whether it can learn accurate bag- and instance-level classifiers remains a question. To address the issue, instance-level classifiers and instance masks were incorporated to ground the prediction on supporting patches. These methods, while practically improving the performance of MIL methods, may potentially introduce noisy labels. We propose to bridge the gap between commonly used MIL and fully supervised learning by augmenting both the bag- and instance-level learning processes with pseudo-label correction capabilities elicited from weak to strong generalization techniques. The proposed algorithm improves the performance of dual-level MIL algorithms on both bag- and instance-level predictions. Experiments on public pathology datasets showcase the advantage of the proposed methods.

Yongquan Yang, Fengling Li, Yani Wei et al.

Recent studies have demonstrated the effectiveness of the combination of machine learning and logical reasoning, including data-driven logical reasoning, knowledge driven machine learning and abductive learning, in inventing advanced technologies for different artificial intelligence applications. One-step abductive multi-target learning (OSAMTL), an approach inspired by abductive learning, via simply combining machine learning and logical reasoning in a one-step balanced multi-target learning way, has as well shown its effectiveness in handling complex noisy labels of a single noisy sample in medical histopathology whole slide image analysis (MHWSIA). However, OSAMTL is not suitable for the situation where diverse noisy samples (DiNS) are provided for a learning task. In this paper, giving definition of DiNS, we propose one-step abductive multi-target learning with DiNS (OSAMTL-DiNS) to expand the original OSAMTL to handle complex noisy labels of DiNS. Applying OSAMTL-DiNS to tumour segmentation for breast cancer in MHWSIA, we show that OSAMTL-DiNS is able to enable various state-of-the-art approaches for learning from noisy labels to achieve more rational predictions. We released a model pre-trained with OSAMTL-DiNS for tumour segmentation in HE-stained pre-treatment biopsy images in breast cancer, which has been successfully applied as a pre-processing tool to extract tumour-associated stroma compartment for predicting the pathological complete response to neoadjuvant chemotherapy in breast cancer.

Cheng Jiang, Jun Liao, Pei Dong et al.

Artificial Intelligence (AI)-powered pathology is a revolutionary step in the world of digital pathology and shows great promise to increase both diagnosis accuracy and efficiency. However, defocus and motion blur can obscure tissue or cell characteristics hence compromising AI algorithms'accuracy and robustness in analyzing the images. In this paper, we demonstrate a deep-learning-based approach that can alleviate the defocus and motion blur of a microscopic image and output a sharper and cleaner image with retrieved fine details without prior knowledge of the blur type, blur extent and pathological stain. In this approach, a deep learning classifier is first trained to identify the image blur type. Then, two encoder-decoder networks are trained and used alone or in combination to deblur the input image. It is an end-to-end approach and introduces no corrugated artifacts as traditional blind deconvolution methods do. We test our approach on different types of pathology specimens and demonstrate great performance on image blur correction and the subsequent improvement on the diagnosis outcome of AI algorithms.