Shujing Guo

Zhengrui Guo, Zhengyu Zhang, Jiabo Ma et al.

Pathological assessment guides lung cancer diagnosis, treatment selection, and prognostic evaluation, yet current CPath approaches rely on task-specific models for isolated objectives. Although pan-cancer foundation models offer versatility, they lack subspecialty-level depth and have not been evaluated across clinical workflows or prospectively validated in real-world settings. We introduce PulmoFoundation, a multi-center, prospectively validated, randomized controlled trial (RCT)-evaluated foundation model for comprehensive lung pathology assessment across pre-operative, intra-operative, and post-operative care. Built upon Virchow2 via subspecialty-specific pretraining using ~40,000 diagnostic H&E-stained whole-slide images (WSIs), PulmoFoundation was systematically evaluated on ~26,000 WSIs across 32 clinically relevant tasks. In addition to accurately predicting molecular markers and patient survival, our model achieves clinical-grade performance in core diagnostic tasks across biopsy, frozen section, and surgical resection slides. In a registered prospective study of 1,357 patients across 11 diagnostic tasks, our model achieved an average AUC of 92.3%. Using pre-specified triage thresholds, PulmoFoundation could reduce additional second-review burden for 68.8% of biopsies and 83.0% of frozen sections, and defer 44.5% of IHC stain orders, with PPVs of 1.0, 0.991, and 0.966. Beyond prospective validation, we conducted a crossover RCT with eight pathologists, in which AI assistance improved diagnostic accuracy across 4,928 case-reader pairs (91.7% w/ AI vs. 83.8% w/o AI). AI assistance also reduced median diagnostic time by 19.6%, increased diagnostic confidence by 8.7%, and improved inter-rater agreement from moderate (kappa = 0.56) to substantial (kappa = 0.76). Together, these evaluations support PulmoFoundation as a clinically validated decision-support system for lung pathology.

Haiyun Guo, ZhiYan Hou, Yu Chen et al.

Multimodal large language models (MLLMs) require continual instruction tuning during their post-training phase to adapt to the dynamic real-world demands. However, the absence of rigorous and systematic benchmarks has hindered progress in this area. To bridge this gap, we introduce \textbf{MLLM-CTBench}, a dataset curating seven challenging tasks from six diverse domains with three contributions. First,to enable fine-grained analysis of continual learning ability, we introduce \textbf{multidimensional evaluation metrics}, which combines final answer accuracy with Chain-of-Thought (CoT) reasoning quality assessment through a carefully trained MLLM evaluator. Then, we conduct a \textbf{comprehensive evaluation of continual learning algorithms}, systematically assessing eight algorithms from four major categories to provide actionable insights for algorithm design and adoption. Finally ,we evaluate the efficacy of \textbf{Reinforcement Fine-tuning (RFT) versus Supervised Fine-tuning (SFT)} in maintaining model performance across sequential tasks during continual instruction tuning. Our experiments demonstrate that reasoning processes in MLLMs exhibit greater resilience than final outputs to forgetting during continual learning, aligning with cognitive theories of hierarchical forgetting. We further show that both model capability and task sequence significantly influence continual learning outcomes, with stronger baseline models exhibiting greater resistance to forgetting. Notably, properly regularized RFT emerges as a more robust approach than SFT for maintaining performance across tasks.One of the key contributing factors is KL-divergence regularization, without which RFT leads to even worse forgetting than SFT on old tasks though may perform better on new tasks.