Initialization matters in few-shot adaptation of vision-language models for histopathological image classification

In computational pathology, few-shot whole slide image classification is primarily driven by the extreme scarcity of expert-labeled slides. Recent vision-language methods incorporate textual semantics generated by large language models, but treat these descriptions as static class-level priors that are shared across all samples and lack sample-wise refinement. This limits both the diversity and precision of visual-semantic alignment, hindering generalization under limited supervision. To overcome this, we propose the stochastic MUlti-view Semantic Enhancement (MUSE), a framework that first refines semantic precision via sample-wise adaptation and then enhances semantic richness through retrieval-augmented multi-view generation. Specifically, MUSE introduces Sample-wise Fine-grained Semantic Enhancement (SFSE), which yields a fine-grained semantic prior for each sample through MoE-based adaptive visual-semantic interaction. Guided by this prior, Stochastic Multi-view Model Optimization (SMMO) constructs an LLM-generated knowledge base of diverse pathological descriptions per class, then retrieves and stochastically integrates multiple matched textual views during training. These dynamically selected texts serve as enriched semantic supervisions to stochastically optimize the vision-language model, promoting robustness and mitigating overfitting. Experiments on three benchmark WSI datasets show that MUSE consistently outperforms existing vision-language baselines in few-shot settings, demonstrating that effective few-shot pathology learning requires not only richer semantic sources but also their active and sample-aware semantic optimization. Our code is available at: https://github.com/JiahaoXu-god/CVPR2026_MUSE.

Multiple instance learning (MIL) has become the main paradigm for whole-slide image (WSI) analysis in computational pathology. However, existing MIL aggregators are still typically trained from scratch for each downstream task, relying on limited slide-level labels to learn both aggregation mechanisms and downstream discriminative representations simultaneously. As a result, they often suffer from unstable optimization, overfitting, and limited transferability. Similar to pretrained ResNet and Vision Transformer models in natural image learning, MIL also requires reusable pretrained initialization. However, high-quality slide-level pretraining data remain scarce, and MIL models are usually lightweight and weakly supervised, making large-scale pretraining difficult in practice. To address this challenge, we propose a distillation-based pretraining framework for MIL, which leverages two slide-level foundation models, TITAN and CARE, as teachers to transfer their representational knowledge into a diverse set of MIL architectures. To effectively balance supervision from different teachers, we further introduce an angular dispersion normalized distillation loss. The distilled weights are then used as initialization for downstream adaptation. We conduct systematic evaluations on 15 benchmark datasets under both linear probing and full-parameter fine-tuning, and further validate its advantages in few-shot scenarios. Experimental results show that pretraining generally improves MIL aggregators over from scratch training, especially in linear-probing and few-shot settings, while maintaining the computational efficiency of lightweight MIL models. Code is available at https://github.com/fu0201/MIL_Pretrained.

Whole Slide Images (WSIs) are giga-pixel in scale and are typically partitioned into small instances in WSI classification pipelines for computational feasibility. However, obtaining extensive instance level annotations is costly, making few-shot weakly supervised WSI classification (FSWC) crucial for learning from limited slide-level labels. Recently, pre-trained vision-language models (VLMs) have been adopted in FSWC, yet they exhibit several limitations. Existing prompt tuning methods in FSWC substantially increase both the number of trainable parameters and inference overhead. Moreover, current methods discard instances with low alignment to text embeddings from VLMs, potentially leading to information loss. To address these challenges, we propose two key contributions. First, we introduce a new parameter efficient prompt tuning method by scaling and shifting features in text encoder, which significantly reduces the computational cost. Second, to leverage not only the pre-trained knowledge of VLMs, but also the inherent hierarchical structure of WSIs, we introduce a WSI representation learning approach with a soft hierarchical textual guidance strategy without utilizing hard instance filtering. Comprehensive evaluations on pathology datasets covering breast, lung, and ovarian cancer types demonstrate consistent improvements up-to 10.9%, 7.8%, and 13.8% respectively, over the state-of-the-art methods in FSWC. Our method reduces the number of trainable parameters by 18.1% on both breast and lung cancer datasets, and 5.8% on the ovarian cancer dataset, while also excelling at weakly-supervised tumor localization. Code at https://github.com/Jayanie/HIPSS.