Whole slide image (WSI) classification is an evidence-driven task, where diagnostic cues are often sparse, spatially organized, and class-dependent. Existing MIL and vision-language methods aggregate a large pool of patch features into a single global slide representation. Under few-shot supervision, limited slide-level labels make it difficult to learn a reliable aggregation mechanism that organizes sparse local cues into compact and coherent diagnostic evidence. Moreover, a shared slide representation compresses evidence supporting a candidate class and its alternatives into the same feature, limiting class-specific reasoning and interpretability. To address these issues, we propose EviBall, a class-conditioned evidence retrieval framework for few-shot WSI classification. EviBall organizes local patches into Evidence Balls through semantic-spatial assignment and center refinement, yielding compact and spatially coherent evidence units under weak supervision. It then uses task-specific class queries, including language-guided queries for morphology-oriented tasks and molecular-guided queries for molecular endpoint prediction, to retrieve supporting evidence balls and produce class-conditioned evidence representations for direct class-wise prediction. By introducing structured evidence units and task-relevant semantic guidance, EviBall reduces the reliance on learning an unconstrained global aggregation mechanism from scarce slide-level labels. It therefore reformulates few-shot WSI classification as structured evidence retrieval and competition among candidate classes. Extensive experiments across four morphology-oriented and molecular endpoint WSI tasks demonstrate that EviBall consistently outperforms conventional and vision-language MIL baselines under diverse few-shot settings, while providing spatially localized and class-specific evidence for each prediction.
Whole-slide images (WSIs) are challenging for vision-language reasoning because diagnostically relevant morphology is sparse, heterogeneous, and distributed across gigapixel-scale images and multiple spatial resolutions. Existing WSI models and pathology agents can aggregate slide features or actively acquire evidence, but the information retained after exploration is often difficult to access semantically while preserving its connection to the original visual evidence. We introduce SlideBank, a training-free framework that represents each WSI as a persistent, concept-indexed, and spatially grounded evidence bank. SlideBank performs question-independent coarse-to-fine exploration to identify informative regions and multi-scale views, converts them into explicit morphological observations, and grounds pathology signals to their supporting patches and WSI coordinates. At inference time, questions are routed to relevant signals and evidence scales, and the linked global, regional, and patch evidence is integrated through confidence-based cross-level consensus. Experiments on WSI-VQA and SlideBench-BCNB show that with Patho-R1, SlideBank reaches 52.77% on WSI-VQA and with Quilt-LLaVA, it reaches 50.92% average accuracy on SlideBench-BCNB, while structured signal-guided retrieval consistently outperforms random evidence sampling. Reusing the same bank across repeated queries further achieves over 99% rephrasing consistency and substantially reduces amortized inference cost through persistent evidence reuse.
Whole-slide image (WSI) reasoning requires an agent to sequentially acquire visual evidence before answering a diagnostic question. Existing training-free agentic frameworks formulate this process as iterative patch retrieval based on semantic relevance to the question. However, semantic relevance does not necessarily imply diagnostic informativeness in computational pathology, where competing diagnoses often exhibit similar and overlapping morphological patterns, making many patches semantically relevant yet diagnostically non-discriminative. Consequently, relevance-based retrieval may acquire redundant observations and leave diagnostic uncertainty unresolved. We propose BEACON, a plug-and-play agentic framework that reformulates WSI reasoning as a Bayesian evidence acquisition problem. BEACON maintains a probabilistic belief over competing diagnostic hypotheses and sequentially acquires patches by maximizing expected information gain (EIG) to reduce diagnostic uncertainty. An evidence controller then determines whether to answer, acquire additional evidence, or perform higher-resolution inspection. Built entirely from off-the-shelf foundation models, BEACON requires no additional training or fine-tuning. Extensive zero-shot experiments across five WSI-VQA benchmarks demonstrate that BEACON achieves the strongest overall performance among training-free agentic frameworks while substantially improving evidence acquisition efficiency, establishing Bayesian evidence acquisition as a principled paradigm for uncertainty-aware agentic WSI reasoning. The code is available at https://github.com/bryanwong17/BEACON
Multiple instance learning (MIL) is the standard approach for whole-slide image (WSI) classification and survival prediction, where attention-based models ag gregate patch features into slide-level predictions. These models treat attention weights as evidence for their predictions, but attention is optimized for classi fication, not for identifying which patches actually support the diagnosis. This conflation leads to three failures: selected patches are insufficient (keeping them alone drops Macro-F1 by 0.078), unnecessary (removing them barely changes the prediction), and unrecoverable (continuous attention scores disagree with discrete patch subsets used at inference). The central premise is that evidence quality should be optimized directly through explicit criteria- Sufficiency, Necessity, and Recov erability (S/N/R)- rather than inherited as a byproduct of classification. GCE-MIL is a backbone-agnostic wrapper implemented through three injection modes and three evidence components: a grounding mechanism that aligns selection with domain-specific concepts, noisy-OR coverage that acts as a differentiable proxy for interventional evidence search, and threshold-plus-repair recovery that converts continuous selectors into discrete subsets through marginal-guided repair. Across 9 backbones and 9 datasets (81 configurations), GCE-MIL improves average Macro-F1 by 0.024 and C-index by 0.014, reduces the continuous-discrete gap by 4-7, and increases complement degradation by 2-4. With optional tile prefiltering after discrete recovery, inference runs up to 5 faster while retaining 0.989 full-bag utility.