Boxiang Yun

Sijing Li, Zhongwei Qiu, Jiang Liu et al.

Accurate tumor analysis is central to clinical radiology and precision oncology, where early detection, reliable lesion characterization, and pathology-level risk assessment guide diagnosis and treatment planning. Chain-of-Thought (CoT) reasoning is particularly important in this setting because it enables step-by-step interpretation from imaging findings to clinical impressions and pathology conclusions, improving traceability and reducing diagnostic errors. Here, we target the clinical tumor analysis task and build a large-scale benchmark that operationalizes a multimodal reasoning pipeline, spanning findings, impressions, and pathology predictions. We curate TumorCoT, a large-scale dataset of 1.5M CoT-labeled VQA instructions paired with 3D CT scans, with step-aligned rationales and cross-modal alignments along the trajectory from findings to impression to pathology, enabling evaluation of both answer accuracy and reasoning consistency. We further propose TumorChain, a multimodal interleaved reasoning framework that tightly couples 3D imaging encoders, clinical text understanding, and organ-level vision-language alignment. Through cross-modal alignment and iterative interleaved causal reasoning, TumorChain grounds visual evidence, aggregates conclusions, and issues pathology predictions after multiple rounds of self-refinement, improving traceability and reducing hallucination risk. Experiments show consistent improvements over strong baselines in lesion detection, impression generation, and pathology classification, and demonstrate strong generalization on the DeepTumorVQA benchmark. These results highlight the potential of multimodal reasoning for reliable and interpretable tumor analysis in clinical practice. Detailed information about our project can be found on our project homepage at https://github.com/ZJU4HealthCare/TumorChain.

Ling Zhang, Boxiang Yun, Ting Jin et al.

Prediction of genetic biomarkers, e.g., microsatellite instability in colorectal cancer is crucial for clinical decision making. But, two primary challenges hamper accurate prediction: (1) It is difficult to construct a pathology-aware representation involving the complex interconnections among pathological components. (2) WSIs contain a large proportion of areas unrelated to genetic biomarkers, which make the model easily overfit simple but irrelative instances. We hereby propose a Dictionary-based hierarchical pathology mining with hard-instance-assisted classifier Debiasing framework to address these challenges, dubbed as D2Bio. Our first module, dictionary-based hierarchical pathology mining, is able to mine diverse and very fine-grained pathological contextual interaction without the limit to the distances between patches. The second module, hard-instance-assisted classfier debiasing, learns a debiased classifier via focusing on hard but task-related features, without any additional annotations. Experimental results on five cohorts show the superiority of our method, with over 4% improvement in AUROC compared with the second best on the TCGA-CRC-MSI cohort. Our analysis further shows the clinical interpretability of D2Bio in genetic biomarker diagnosis and potential clinical utility in survival analysis. Code will be available at https://github.com/DeepMed-Lab-ECNU/D2Bio.

Yadong Lu, Shitian Zhao, Boxiang Yun et al.

Despite recent progress in enhancing the efficacy of Open-Domain Continual Learning (ODCL) in Vision-Language Models (VLM), failing to (1) correctly identify the Task-ID of a test image and (2) use only the category set corresponding to the Task-ID, while preserving the knowledge related to each domain, cannot address the two primary challenges of ODCL: forgetting old knowledge and maintaining zero-shot capabilities, as well as the confusions caused by category-relatedness between domains. In this paper, we propose a simple yet effective solution: leveraging intra-domain category-aware prototypes for ODCL in CLIP (DPeCLIP), where the prototype is the key to bridging the above two processes. Concretely, we propose a training-free Task-ID discriminator method, by utilizing prototypes as classifiers for identifying Task-IDs. Furthermore, to maintain the knowledge corresponding to each domain, we incorporate intra-domain category-aware prototypes as domain prior prompts into the training process. Extensive experiments conducted on 11 different datasets demonstrate the effectiveness of our approach, achieving 2.37% and 1.14% average improvement in class-incremental and task-incremental settings, respectively.

Yunhao Bai, Boxiang Yun, Zeli Chen et al.

The Segment Anything Model 2 (SAM2) has recently demonstrated exceptional performance in zero-shot prompt segmentation for natural images and videos. However, when the propagation mechanism of SAM2 is applied to medical images, it often results in spatial inconsistencies, leading to significantly different segmentation outcomes for very similar images. In this paper, we introduce RevSAM2, a simple yet effective self-correction framework that enables SAM2 to achieve superior performance in unseen 3D medical image segmentation tasks without the need for fine-tuning. Specifically, to segment a 3D query volume using a limited number of support image-label pairs that define a new segmentation task, we propose reverse propagation strategy as a query information selection mechanism. Instead of simply maintaining a first-in-first-out (FIFO) queue of memories to predict query slices sequentially, reverse propagation selects high-quality query information by leveraging support images to evaluate the quality of each predicted query slice mask. The selected high-quality masks are then used as prompts to propagate across the entire query volume, thereby enhancing generalization to unseen tasks. Notably, we are the first to explore the potential of SAM2 in label-efficient medical image segmentation without fine-tuning. Compared to fine-tuning on large labeled datasets, the label-efficient scenario provides a cost-effective alternative for medical segmentation tasks, particularly for rare diseases or when dealing with unseen classes. Experiments on four public datasets demonstrate the superiority of RevSAM2 in scenarios with limited labels, surpassing state-of-the-arts by 12.18% in Dice. The code will be released.

Ling Zhang, Boxiang Yun, Qingli Li et al.

Automated pathology report generation from Whole Slide Images (WSIs) faces two key challenges: (1) lack of semantic content in visual features and (2) inherent information redundancy in WSIs. To address these issues, we propose a novel Historical Report Guided \textbf{Bi}-modal Concurrent Learning Framework for Pathology Report \textbf{Gen}eration (BiGen) emulating pathologists' diagnostic reasoning, consisting of: (1) A knowledge retrieval mechanism to provide rich semantic content, which retrieves WSI-relevant knowledge from pre-built medical knowledge bank by matching high-attention patches and (2) A bi-modal concurrent learning strategy instantiated via a learnable visual token and a learnable textual token to dynamically extract key visual features and retrieved knowledge, where weight-shared layers enable cross-modal alignment between visual features and knowledge features. Our multi-modal decoder integrates both modals for comprehensive diagnostic reports generation. Experiments on the PathText (BRCA) dataset demonstrate our framework's superiority, achieving state-of-the-art performance with 7.4\% relative improvement in NLP metrics and 19.1\% enhancement in classification metrics for Her-2 prediction versus existing methods. Ablation studies validate the necessity of our proposed modules, highlighting our method's ability to provide WSI-relevant rich semantic content and suppress information redundancy in WSIs. Code is publicly available at https://github.com/DeepMed-Lab-ECNU/BiGen.

Ling Zhang, Boxiang Yun, Xingran Xie et al.

Prediction of genetic biomarkers, e.g., microsatellite instability and BRAF in colorectal cancer is crucial for clinical decision making. In this paper, we propose a whole slide image (WSI) based genetic biomarker prediction method via prompting techniques. Our work aims at addressing the following challenges: (1) extracting foreground instances related to genetic biomarkers from gigapixel WSIs, and (2) the interaction among the fine-grained pathological components in WSIs.Specifically, we leverage large language models to generate medical prompts that serve as prior knowledge in extracting instances associated with genetic biomarkers. We adopt a coarse-to-fine approach to mine biomarker information within the tumor microenvironment. This involves extracting instances related to genetic biomarkers using coarse medical prior knowledge, grouping pathology instances into fine-grained pathological components and mining their interactions. Experimental results on two colorectal cancer datasets show the superiority of our method, achieving 91.49% in AUC for MSI classification. The analysis further shows the clinical interpretability of our method. Code is publicly available at https://github.com/DeepMed-Lab-ECNU/PromptBio.

Boxiang Yun, Yan Wang, Jieneng Chen et al.

Hyperspectral imaging (HSI) unlocks the huge potential to a wide variety of applications relied on high-precision pathology image segmentation, such as computational pathology and precision medicine. Since hyperspectral pathology images benefit from the rich and detailed spectral information even beyond the visible spectrum, the key to achieve high-precision hyperspectral pathology image segmentation is to felicitously model the context along high-dimensional spectral bands. Inspired by the strong context modeling ability of transformers, we hereby, for the first time, formulate the contextual feature learning across spectral bands for hyperspectral pathology image segmentation as a sequence-to-sequence prediction procedure by transformers. To assist spectral context learning procedure, we introduce two important strategies: (1) a sparsity scheme enforces the learned contextual relationship to be sparse, so as to eliminates the distraction from the redundant bands; (2) a spectral normalization, a separate group normalization for each spectral band, mitigates the nuisance caused by heterogeneous underlying distributions of bands. We name our method Spectral Transformer (SpecTr), which enjoys two benefits: (1) it has a strong ability to model long-range dependency among spectral bands, and (2) it jointly explores the spatial-spectral features of HSI. Experiments show that SpecTr outperforms other competing methods in a hyperspectral pathology image segmentation benchmark without the need of pre-training. Code is available at https://github.com/hfut-xc-yun/SpecTr.