A Proper Scoring Rule for Virtual Staining

Liver fibrosis, the principal predictor of long-term outcome in chronic liver disease, is staged from histological estimates of collagen content. Sirius Red (SR) provides the standard quantitative readout (collagen proportionate area, CPA) but is not acquired at every clinical centre and consumes tissue, time, and reagent cost beyond the routine Hematoxylin and eosin (H&E) stain. AI-based virtual staining can generate SR directly from H&E, yet systematic benchmarks of unsupervised models are scarce and their predictive uncertainty has not been quantified, even though visually plausible outputs may not faithfully reproduce the underlying tissue structure. We therefore benchmark six unsupervised image-to-image architectures (GAN-based and diffusion-based) across 54 scaling configurations on a newly released paired H&E to SR mouse liver dataset, the first open resource for this translation task. Each configuration is evaluated jointly on perceptual, distributional, and task-specific axes plus a blinded expert reader study; the best per family is then retrained as a deep ensemble, the first systematic comparison of epistemic uncertainty across unsupervised stain-to-stain architectures. Across families, perceptual quality, task-specific error, and ensemble agreement measure largely independent axes of model fitness: GAN-based methods cluster tightly on perceptual metrics yet differ substantially on task error and ensemble agreement, while the diffusion-based method (CycleDiffusion) is qualitatively different on all three. No single metric captures these differences, so reliable virtual staining requires reporting and selecting on all three jointly. The dataset, tiling pipeline, models, and evaluation code are released publicly.

Virtual immunohistochemistry (IHC) staining from hematoxylin and eosin (H&E) images can accelerate diagnostics by providing preliminary molecular insight directly from routine sections, reducing the need for repeat sectioning when tissue is limited. Existing methods improve realism through contrastive objectives, prototype matching, or domain alignment, yet the generator itself receives no direct guidance from pathology foundation models. We present UNIStainNet, a SPADE-UNet conditioned on dense spatial tokens from a frozen pathology foundation model (UNI), providing tissue-level semantic guidance for stain translation. A misalignment-aware loss suite preserves stain quantification accuracy, and learned stain embeddings enable a single model to serve multiple IHC markers simultaneously. On MIST, UNIStainNet achieves state-of-the-art distributional metrics on all four stains (HER2, Ki67, ER, PR) from a single unified model, where prior methods typically train separate per-stain models. On BCI, it also achieves the best distributional metrics. A tissue-type stratified failure analysis reveals that remaining errors are systematic, concentrating in non-tumor tissue. Code is available at https://github.com/facevoid/UNIStainNet.

Virtual staining of histopathology images (e.g., H&E-IHC) is an emerging tool in digital pathology, enabling faster and cheaper workflows by synthesizing target stains from routinely acquired slides. Yet, the quality of virtual staining models is still predominantly assessed with generic metrics such as SSIM, PSNR, and LPIPS. Originally developed for natural images, these metrics are inherently misaligned with the domain-specific characteristics of histological data, failing to capture tissue morphology preservation and biomarker expression patterns. Consequently, a robust, domain-specific standard for quantifying similarity across diverse histological modalities remains a critical gap in the field. In this work, we formalize histology image similarity as a standalone problem and systematically evaluate a broad set of full-reference metrics against a dataset of H&E-IHC patch pairs annotated with expert similarity scores. We further analyze metrics sensitivity to controlled geometric distortions (shifts, rotations and non-rigid deformations) that mimic realistic registration errors between serial sections. Guided by these observations, we propose the Histology-Aware Perceptual Similarity (HAPS) metric. HAPS computes distances in the feature space of a frozen encoder pretrained on histopathology data, adding a linear head to aggregate feature-level differences into a final score that aligns with expert assessments. Finally, we demonstrate the practical value of HAPS for quality control of training data. By quantifying the similarity of training pairs in the MIST dataset and filtering low-scoring samples, we create a cleaner training set. Virtual staining models trained on this refined data outperform those trained on the original, unfiltered dataset.