J.A. Jeong

Sungrae Hong, Jiwon Jeong, Jisu Shin et al.

Multiple Instance Learning (MIL) has emerged as a promising paradigm for Whole Slide Image (WSI) diagnosis, offering effective learning with limited annotations. However, existing MIL frameworks overlook diagnostic priorities and fail to differentiate the severity of misclassifications in multiclass, leaving clinically critical errors unaddressed. We propose a mistake-severity-aware training strategy that organizes diagnostic classes into a hierarchical structure, with each level optimized using a severity-weighted cross-entropy loss that penalizes high-severity misclassifications more strongly. Additionally, hierarchical consistency is enforced through probabilistic alignment, a semantic feature remix applied to the instance bag to robustly train class priority and accommodate clinical cases involving multiple symptoms. An asymmetric Mikel's Wheel-based metric is also introduced to quantify the severity of errors specific to medical fields. Experiments on challenging public and real-world in-house datasets demonstrate that our approach significantly mitigates critical errors in MIL diagnosis compared to existing methods. We present additional experimental results on natural domain data to demonstrate the generalizability of our proposed method beyond medical contexts.

Sungrae Hong, Jiwon Jeong, Soeun Cheon et al.

Multiple Instance Learning (MIL) is a standard paradigm for Whole-Slide Image (WSI) analysis and has achieved strong results in computational pathology. However, most MIL pipelines assume a single "gold" label per slide, which conflicts with clinical practice where substantial inter-pathologist variability is common. Existing multi-annotator learning and label-refinement methods typically estimate global annotator reliability or rely on single-instance assumptions, making them poorly suited to MIL and to localized diagnostic contexts where experts disagree. We propose RaLMPH (Reliability-aware Learning for Multi-Pathologist Harmonization), a MIL-based label reconciliation framework for WSIs annotated by multiple pathologists. RaLMPH introduces a reliability field that jointly models (i) local neighborhood structure in WSI feature space and (ii) expert uncertainty (entropy), enabling per-sample identification of trustworthy reference neighborhoods. Leveraging this field, RaLMPH performs sample-wise local annotator ranking to select reliable opinions per slide and applies an adaptive gating mechanism to fuse labels conditioned on local reliability. Experiments on a clinical WSI dataset with labels from six pathologists, as well as controlled simulated benchmarks, show that RaLMPH consistently outperforms existing approaches. Further analyses clarify how our reliability-aware mechanism improves label reconciliation and downstream MIL performance.