Yingkang Zhan

Jiusong Ge, Yingkang Zhan, Wenjie Zhao et al.

Traditional whole slide image (WSI) analysis methods typically rely on the multiple instance learning (MIL) paradigm, which extracts patch-level features at high magnification and aggregates them for slide-level prediction. However, such exhaustive patch-level processing is computationally expensive, severely limiting the efficiency and scalability of WSI analysis. To address this challenge, we propose PathCTM (a Pathology-oriented Continuous Thought Model) that enables token-efficient scale-space continuous reasoning for gigapixel WSIs. PathCTM formulates diagnostic inference as a dynamic sequential information pursuit. It progressively transitions from low-magnification global to high-magnification local inspection, and adaptively terminates inference when sufficient evidence is gathered to effectively bound decision uncertainty. Specifically, it uses conditional computation for dynamic scale switching with attention-guided region pruning, coupled with confidence-aware early stopping. Extensive experiments demonstrate that, compared with standard MIL-based methods, PathCTM reduces the number of required image patches by 95.95% and shortens inference time by approximately 95.62%, while maintaining AUC without degradation. Code is available at https://github.com/JSGe-AI/PathCTM.

Jiashuai Liu, Yingjia Shang, Yingkang Zhan et al.

With the widespread adoption of pathology foundation models in both research and clinical decision support systems, exploring their security has become a critical concern. However, despite their growing impact, the vulnerability of these models to adversarial attacks remains largely unexplored. In this work, we present the first systematic investigation into the security of pathology foundation models for whole slide image~(WSI) analysis against adversarial attacks. Specifically, we introduce the principle of \textit{local perturbation with global impact} and propose a label-free attack framework that operates without requiring access to downstream task labels. Under this attack framework, we revise four classical white-box attack methods and redefine the perturbation budget based on the characteristics of WSI. We conduct comprehensive experiments on three representative pathology foundation models across five datasets and six downstream tasks. Despite modifying only 0.1\% of patches per slide with imperceptible noise, our attack leads to downstream accuracy degradation that can reach up to 20\% in the worst cases. Furthermore, we analyze key factors that influence attack success, explore the relationship between patch-level vulnerability and semantic content, and conduct a preliminary investigation into potential defence strategies. These findings lay the groundwork for future research on the adversarial robustness and reliable deployment of pathology foundation models. Our code is publicly available at: https://github.com/Jiashuai-Liu-hmos/Attack-WSI-pathology-foundation-models.

Yi Niu, Jiashuai Liu, Yingkang Zhan et al.

Spatial Transcriptomics (ST) reveals the spatial distribution of gene expression in tissues, offering critical insights into biological processes and disease mechanisms. However, the high cost, limited coverage, and technical complexity of current ST technologies restrict their widespread use in clinical and research settings, making obtaining high-resolution transcriptomic profiles across large tissue areas challenging. Predicting ST from H\&E-stained histology images has emerged as a promising alternative to address these limitations but remains challenging due to the heterogeneous relationship between histomorphology and gene expression, which is affected by substantial variability across patients and tissue sections. In response, we propose PH2ST, a prompt-guided hypergraph learning framework, which leverages limited ST signals to guide multi-scale histological representation learning for accurate and robust spatial gene expression prediction. Extensive evaluations on two public ST datasets and multiple prompt sampling strategies simulating real-world scenarios demonstrate that PH2ST not only outperforms existing state-of-the-art methods, but also shows strong potential for practical applications such as imputing missing spots, ST super-resolution, and local-to-global prediction, highlighting its value for scalable and cost-effective spatial gene expression mapping in biomedical contexts.