Multimodal Knowledge Distillation for Gastric Adenocarcinoma Classification from Whole-Slide Images

Accurate differentiation between gastric adenoma and carcinoma during endoscopy is critical for clinical decision-making. Yet, this task is highly challenging due to high inter-class similarity and ambiguous boundaries between the two classes. Existing ROI-based classification methods often suffer from detection/segmentation error propagation and loss of surrounding global context. In contrast, full-image classification lacks the necessary spatial focus. Furthermore, we observe that deep neural networks gravitate towards domain-specific texture biases(e.g. bleeding, lighting artifacts), often causing models to predict based on spurious correlations instead of intrinsic morphological features. To address these limitations, we propose a novel framework, Masked Achromatic Guidance Expert (MAGE). During training, we introduce an auxiliary local expert branch trained on masked achromatic views of the neoplasm. By suppressing background context and color, this branch is forced to learn highly discriminative, purely structural features. We then employ a dual-objective distillation strategy, transferring both classification logits and spatial attention maps to provide implicit spatial supervision to the main branch that receives full WLI as input. This dual-objective distillation forces the model to ground its predictions in morphology rather than relying on shortcuts, while still retaining clinically relevant color cues. At inference time, our deployable model operates on images without annotated masks, ensuring real-time deployability . Extensive experiments on a clinical gastric endoscopy dataset show that our method significantly outperforms existing detection-based methodologies (e.g. YOLO) and classification-based methodologies (e.g. Swin-Transformer), providing not only superior classification performance but also interpretable attention maps for clinical reliability.

Histopathological whole slide images (WSIs) are central to cancer diagnosis, but their gigapixel scale, tissue heterogeneity, weak slide-level supervision, sparse diagnostic regions, and multi-scale evidence make robust automated analysis challenging. Multiple instance learning (MIL) is widely used to aggregate tile-level features into slide-level predictions, yet existing augmentation strategies often perturb tissue regions without preserving diagnostic relevance, slide context, or cross-scale structure. We propose SlideMix, a model-agnostic multimodal augmentation framework for MIL-based WSI analysis. SlideMix uses a retrieval-augmented vision-language model (VLM)-based Visual-Language Adaptive Region selector to identify diagnostically relevant regions and reduce weak-label noise. It then performs In-place Tile Shuffling within meaningful tissue regions to mix feature embeddings while preserving slide-level context. A VLM-based soft-labeling module supervises mixed samples, while a multi-factor, loss-driven online Curriculum-Learning Feedback scheme adaptively controls shuffle granularity, feature similarity, and shuffle ratio to promote cross-scale representation learning. Across 11 WSI datasets comprising 20,523 slides, 8 diagnostic tasks, and 10 WSI backbones, SlideMix improves accuracy and generalization in most settings and compares favorably with established augmentation baselines, providing a simple plug-and-play approach for more robust and scalable digital pathology models. Source code: https://github.com/Xia-Research-Lab/SlideMix

Whole slide image (WSI) analysis in computational pathology follows a multiple instance learning (MIL) pipeline where patch embeddings are extracted independently and aggregated for slide-level prediction, but within-slide variance from staining, scanner, and local texture can overwhelm the discriminative signal. We propose Masked Feature Encoding for Multiple Instance Learning (MFE-MIL), a feature-space masking framework that trains a lightweight MLP adapter jointly with a window-based masked reconstruction branch and a MIL classification head. The two objectives are complementary. Classification guides the adapter to suppress within-slide patch variance, while window-based masked reconstruction provides an auxiliary regularizer for the adapted features without using patch coordinates, coordinate graphs, or segmentation preprocessing. The raster patch-extraction order is used only as a weak implicit prior. At inference, the decoder is removed, leaving only the adapter and MIL head. Across CAMELYON16/17, PANDA, and TCGA-BRCA with four diverse encoders, MFE-MIL improves ACC/F1 for nearly all tested aggregator-encoder settings and AUC in most, outperforms coordinate-based spatial methods (CAMIL), and achieves higher AUC than 2DMamba on three of four datasets (UNI). On five TCGA survival cohorts it improves the average concordance index for every aggregator tested, its most consistent gain. Code is available at https://github.com/AtlasAnalyticsLab/MFE-MIL.