ConceptM3oE: Concept-Guided Multimodal Mixture of Experts for Interpretable Computational Pathology
Authors: Xuan Wang, Zhongling Xu, Gopi Kannedhara, Joakim Nguyen, Jian Yu, Jinrui Fang, Abdurrahmaan Baghdadi, Tianlong Chen, +8 more
Organizations: University of Texas at Austin, Austin, TX, USA · University of North Carolina at Chapel Hill, NC, USA · Dell Children’s Medical Center, Austin, TX, USA · The University of Texas MD Anderson Cancer Center, Houston, TX, USA · University of Nevada, Reno, NV, USA
Healthcare models are transitioning from unimodal prediction toward multimodal reasoning over heterogeneous diagnostic inputs. In computational pathology, for complex tumor subtypes where morphology alone can be challenging to distinguish, pathology reports and molecular measurements may provide additional diagnostic evidence alongside whole-slide images, yet existing models often fail to clarify how diverse signals assemble into recognizable diagnostic concepts. We propose ConceptM3oE (Concept Multimodal MoE), which embeds concept formation directly within interaction-aware mixture-of-experts (MoE) pathways. The architecture decomposes evidence into modality-specific, redundant, and synergistic experts, which are then projected into structured concept bottlenecks mapping latent features to a hierarchy of morphology and biomarker concepts. To prevent the information loss typical of interpretable bottlenecks, we utilize residual pathways within each expert to allow task-relevant signals to flow both through the concepts and directly to the final task prediction, so that high performance is maintained alongside interpretability. Across an institutional pediatric brain tumor cohort and a public glioma cohort, the framework delivers competitive performance to unconstrained models while producing reasoning traces validated by an independent neuropathologist. In data-limited regimes, ConceptM3oE improves limited-data performance, increasing macro-F1 from 56.41% to 66.70% at small training sizes compared to non-concept-informed baselines, while also showing faster training convergence consistent with the regularizing effect of concept learning. This work offers a scalable path toward high-performance medical AI that is inherently verifiable and better aligned with the complex decision-making of clinical practice.
Concept bottleneck models (CBMs) can improve the transparency of cancer image diagnostic prediction by expressing predictions through radiological concepts. However, their dependence on instance-level concept annotations limits practical applicability. We propose a prior-guided hybrid CBM that integrates limited concept annotations, class-conditional concept distribution matching on unannotated patients, and prior initialization of the concept-to-diagnosis head. We evaluate the method on CBIS-DDSM mammographic masses and calcifications and LIDC-IDRI pulmonary nodules across 0-100% concept annotation. In the clinically relevant 0-20% annotation regime, the hybrid CBM consistently improves mean concept AUC over a matched standard CBM, while maintaining diagnostic performance close to black-box models. At 10% annotation specifically, concept AUC increases from 0.619 to 0.741 for masses, from 0.650 to 0.787 for calcifications, and from 0.597 to 0.642 for pulmonary nodules. Ablation experiments identify prior initialization as the main component contributing to improved concept detection, likely by stabilizing the concept-to-diagnosis head. Zero-shot VLMs remain insufficient for reliable fine-grained tumor-level concept prediction. These findings suggest that structured priors can substantially reduce the annotation burden of interpretable cancer imaging models.
AI models for multimodal medical imaging must balance modality-specific specialization with cross-modal shared representations, a trade-off that pure Mixture-of-Experts (MoE) architectures currently fail to satisfy. Expert-based routing improves in-domain learning but may sacrifice cross-modal signals, which appear particularly important for rare (low-prevalence) pathologies in our experiments. To resolve this, we introduce Generalist-Specialist-MoE (GS-MoE), a two-branch (MoE) architecture that couples a cross-modal generalist model with distinct modality-specific specialists (experts) via domain-constrained feature fusion. On RadImageNet (1.35M images, 165 pathologies, three modalities), GS-MoE recovers detection of six low-prevalence pathologies on which every baseline scores F1 = 0, with per-class gains up to +0.60 F1. It attains this while even slightly exceeding dense and specialist-only MoE aggregate baselines (MCC 0.770), while using ∼53% fewer active parameters at inference than the strongest investigated dense model.
Johannes Kaiser, Florian Braunmiller, Daniel Rückert +1
Multimodal large language models (MLLMs) are increasingly used to analyze pathology images. However, dominant multimodal benchmarks in pathology mainly score final diagnostic answers, captions, or reports. These evaluations provide limited insight into whether a model understands the multiscale visual content needed for pathology reasoning and decision-making. We introduce PathVU, a vision-anchored benchmark for fine-grained and multiscale visual understanding in computational pathology. Built from 23 public pathology imaging datasets with human-supervised labels and spatial annotations, PathVU evaluates MLLM understanding in two fields of view: Region FOV for high-resolution local regions and Slide FOV for macro whole-slide views. By converting raw annotations into deterministic task targets, PathVU enables programmatic scoring of region localization, visual recognition, quantity estimation, spatial reasoning, and insufficient-context judgment. The benchmark contains 14 VQA-style tasks, 61,673 images, and 308,070 samples across 28 organs and 7,253,526 annotations. Evaluating 18 representative general-purpose, medical-domain, and pathology-oriented MLLMs, we observe substantial limitations even in advanced models on fine-grained visual tasks across multiscale pathology images. PathVU provides a reproducible basis for developing and evaluating pathology MLLMs with explicit multiscale visual understanding.