Pablo Meseguer

Pablo Meseguer, Rocío del Amor, Valery Naranjo

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, 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 multiple-instance 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. Code coming soon at thttps://github.com/cvblab/MIVisionShot.

Ilán Carretero, Pablo Meseguer, Rocío del Amor et al.

Domain shift in the field of histopathological imaging is a common phenomenon due to the intra- and inter-hospital variability of staining and digitization protocols. The implementation of robust models, capable of creating generalized domains, represents a need to be solved. In this work, a new domain adaptation method to deal with the variability between histopathological images from multiple centers is presented. In particular, our method adds a training constraint to the supervised contrastive learning approach to achieve domain adaptation and improve inter-class separability. Experiments performed on domain adaptation and classification of whole-slide images of six skin cancer subtypes from two centers demonstrate the method's usefulness. The results reflect superior performance compared to not using domain adaptation after feature extraction or staining normalization.

Pablo Meseguer, Rocío del Amor, Adrian Colomer et al.

Since the emergence of the ImageNet dataset, the pretraining and fine-tuning approach has become widely adopted in computer vision due to the ability of ImageNet-pretrained models to learn a wide variety of visual features. However, a significant challenge arises when adapting these models to domain-specific fields, such as digital pathology, due to substantial gaps between domains. To address this limitation, foundation models (FM) have been trained on large-scale in-domain datasets to learn the intricate features of histopathology images. In cancer diagnosis, whole-slide image (WSI) prediction is essential for patient prognosis, and multiple instance learning (MIL) has been implemented to handle the giga-pixel size of WSI. As MIL frameworks rely on patch-level feature aggregation, this work aims to compare the performance of various feature extractors developed under different pretraining strategies for cancer subtyping on WSI under a MIL framework. Results demonstrate the ability of foundation models to surpass ImageNet-pretrained models for the prediction of six skin cancer subtypes

Pablo Meseguer, Rocío del Amor, Valery Naranjo

Vision language models (VLM) pre-trained on datasets of histopathological image-caption pairs enabled zero-shot slide-level classification. The ability of VLM image encoders to extract discriminative features also opens the door for supervised fine-tuning for whole-slide image (WSI) classification, ideally using few labeled samples. Slide-level prediction frameworks require the incorporation of multiple instance learning (MIL) due to the gigapixel size of the WSI. Following patch-level feature extraction and aggregation, MIL frameworks rely on linear classifiers trained on top of the slide-level aggregated features. Classifier weight initialization has a large influence on Linear Probing performance in efficient transfer learning (ETL) approaches based on few-shot learning. In this work, we propose Zero-Shot Multiple-Instance Learning (ZS-MIL) to address the limitations of random classifier initialization that underperform zero-shot prediction in MIL problems. ZS-MIL uses the class-level embeddings of the VLM text encoder as the classification layer's starting point to compute each sample's bag-level probabilities. Through multiple experiments, we demonstrate the robustness of ZS-MIL compared to well-known weight initialization techniques both in terms of performance and variability in an ETL few-shot scenario for subtyping prediction.

Santiago Moreno, Pablo Meseguer, Rocío del Amor et al.

Accurate annotation of cutaneous neoplasm biopsies represents a major challenge due to their wide morphological variability, overlapping histological patterns, and the subtle distinctions between benign and malignant lesions. Vision-language foundation models (VLMs), pre-trained on paired image-text corpora, learn joint representations that bridge visual features and diagnostic terminology, enabling zero-shot localization and classification of tissue regions without pixel-level labels. However, most existing VLM applications in histopathology remain limited to slide-level tasks or rely on coarse interactive prompts, and they struggle to produce fine-grained segmentations across gigapixel whole-slide images (WSIs). In this work, we introduce a zero-shot visual-language segmentation pipeline for whole-slide images (ZEUS), a fully automated, zero-shot segmentation framework that leverages class-specific textual prompt ensembles and frozen VLM encoders to generate high-resolution tumor masks in WSIs. By partitioning each WSI into overlapping patches, extracting visual embeddings, and computing cosine similarities against text prompts, we generate a final segmentation mask. We demonstrate competitive performance on two in-house datasets, primary spindle cell neoplasms and cutaneous metastases, highlighting the influence of prompt design, domain shifts, and institutional variability in VLMs for histopathology. ZEUS markedly reduces annotation burden while offering scalable, explainable tumor delineation for downstream diagnostic workflows.

Pablo Meseguer, Rocío del Amor, Valery Naranjo

Pretraining on large-scale, in-domain datasets grants histopathology foundation models (FM) the ability to learn task-agnostic data representations, enhancing transfer learning on downstream tasks. In computational pathology, automated whole slide image analysis requires multiple instance learning (MIL) frameworks due to the gigapixel scale of the slides. The diversity among histopathology FMs has highlighted the need to design real-world challenges for evaluating their effectiveness. To bridge this gap, our work presents a novel benchmark for evaluating histopathology FMs as patch-level feature extractors within a MIL classification framework. For that purpose, we leverage the AI4SkIN dataset, a multi-center cohort encompassing slides with challenging cutaneous spindle cell neoplasm subtypes. We also define the Foundation Model - Silhouette Index (FM-SI), a novel metric to measure model consistency against distribution shifts. Our experimentation shows that extracting less biased features enhances classification performance, especially in similarity-based MIL classifiers.

Alvaro Pastor-Naranjo, Pablo Meseguer, Rocío del Amor et al.

Ewing's sarcoma (ES), characterized by a high density of small round blue cells without structural organization, presents a significant health concern, particularly among adolescents aged 10 to 19. Artificial intelligence-based systems for automated analysis of histopathological images are promising to contribute to an accurate diagnosis of ES. In this context, this study explores the feature extraction ability of different pre-training strategies for distinguishing ES from other soft tissue or bone sarcomas with similar morphology in digitized tissue microarrays for the first time, as far as we know. Vision-language supervision (VLS) is compared to fully-supervised ImageNet pre-training within a multiple instance learning paradigm. Our findings indicate a substantial improvement in diagnostic accuracy with the adaption of VLS using an in-domain dataset. Notably, these models not only enhance the accuracy of predicted classes but also drastically reduce the number of trainable parameters and computational costs.