Conditioning noise is a free regularizer for LoRA fine-tuning: no pathology encoder required for diffusion-based artifact detection in histopathology

One-class artifact detectors for whole-slide images learn normal tissue from a clean training pool and flag departures from it. The pool is built by a preprocessing pipeline whose tissue-detection step is usually treated as neutral. We tested whether it is. On 16 annotated slides from The Cancer Genome Atlas, we rebuilt the clean pool of a diffusion-based detector with different tissue detection methods and compared the resulting models in a four-fold cross-validation. Per-slide saturation-Otsu detection excluded normal tissue, chiefly tissue with large clear spaces such as adipose tissue and alveolar parenchyma, and on slides with thick marker ink kept the ink while excluding ordinary tissue. Replacing it with entropy-based detection reduced the false-positive fraction on held-out clean slides from 0.102 to 0.016, in every fold and with a second training seed, without loss of sensitivity; the gain came from the composition of the pool, not its size. Across three tissue detection methods, false positives followed the fraction of such clear-space tissue in the pool, a statistic that needs no labels or training (0.103, 0.016 and 0.009). The effect did not carry over at the same size to a nearest-neighbour detector on foundation-model features. On an external cohort, the curated pool lowered clean-control false positives by about 20%, far less than on the development slides, and the remaining cross-center loss was not explained by stain differences. For one-class quality control, tissue detection decides what the model learns as normal and should be chosen and reported accordingly.

Background and Objective: Quality control is a prerequisite for whole-slide image analysis, yet the benchmarks on which quality-control methods are compared share four properties that make their reported differences hard to interpret: few independent slides, annotation concentrated in a minority of them, pooled ratio metrics with no closed-form standard error, and a single inherited train/test partition. We propose a reliability protocol for such benchmarks. Methods: The protocol quantifies four sources of variability - test-set sampling, training stochasticity, partition composition, and undocumented preprocessing - a claim is reportable only if it survives all four; three of the four cost minutes of compute. We apply it to an independent reconstruction of a published diffusion-based artifact detector, evaluated on the original 24-slide partition and against a supervised baseline. Results: The method's central mechanism reproduces: the auxiliary contrastive term improves pooled F1 from 0.673 to 0.688 and replicates under a second seed (+0.0156, p = 0.031; +0.0190, p = 0.005), although it acts on pen marking rather than the artifact types cited to motivate it. Its comparative claims do not: differences between design variants, and against the supervised baseline, fall inside the uncertainty of the evaluation. Four of 24 slides carry 70% of scored annotated pixels, giving an effective sample size of 6.2, and the inherited partition sits at the 7th percentile. An unreported tissue-restriction step excludes 41.4% of out-of-focus annotation against 2.6% of air bubble; such a gate is confounded with blur by construction. Conclusions: Small-cohort benchmarks support far weaker conclusions than current reporting implies. The four checks are cheap enough to accompany any evaluation on such a resource and separate reproducible effects from differences the evaluation cannot resolve.

Although deep learning has advanced Whole Slide Image (WSI) Analysis, tissue artifacts like bubbles and folds often cause silent failures by concealing essential morphology. Current pathology image restoration methods are mostly restricted to small patches, struggling to maintain global structural coherence at a megapixel scale. We introduce RestorePath, a framework for globally consistent megapixel scale inpainting that reconstructs diagnostic structures in histological image to prevent incorrect high-confidence predictions and lower error rates. Our model utilizes a Latent Diffusion Model (LDM) conditioned on Pathology Foundation Model (PFM) embeddings, integrating Large Kernel Attention (LKA) to manage long-range dependencies during random patch diffusion. Enhanced by Distance-Weighted Interpolation (DWI) and an Adaptive Guidance Scale (AGS), RestorePath ensures structural consistency and fidelity by modulating information from surrounding patches. Evaluations across TCGA-BRCA, BACH, and Camelyon16 datasets for images ranging from 512 to 4608 pixels demonstrate state-of-the-art performance in maintaining histological consistency. RestorePath significantly improves downstream Computational Pathology (CP) tasks, outperforming both raw artifact images and the conventional Detect-and-Discard (D&D) approach. The code is available at https://github.com/PathfinderLab/RestorePath