MP-MNCA: Morphology-Prior Masked Neighbor Cross-Attention for Efficient Spatial Domain Identification

Spatial transcriptomics (ST) enables genome-wide gene expression profiling while preserving tissue architecture, but its cost and limited scalability remain major bottlenecks. This has motivated models that predict spatial expression directly from routine histology. Despite promising results, most existing approaches operate at the gene level without leveraging established transcriptomic modeling practices and rely on heterogeneous gene selection strategies, which complicates fair comparison across methods. We propose to reformulate morphology-to-transcriptomics prediction as conditional generation in transcriptional program space, thereby exploiting coordinated transcriptional variation instead of predicting genes independently. Using consensus non-negative matrix factorization (cNMF), we extract a low-dimensional set of transcriptional programs capturing coordinated expression variation in the training data, and train a conditional diffusion model to generate program activations from histology. This formulation exploits coordinated transcriptional variation and substantially lowers the dimensionality of the conditional generative task.

Pathology foundation models learn morphological representations through self-supervised pretraining on large-scale whole-slide images, yet they do not explicitly capture the underlying molecular state of the tissue. Spatial transcriptomics technologies bridge this gap by measuring gene expression in situ, offering a natural cross-modal supervisory signal. We propose MINT (Molecularly Informed Training), a fine-tuning framework that incorporates spatial transcriptomics supervision into pretrained pathology Vision Transformers. MINT appends a learnable ST token to the ViT input to encode transcriptomic information separately from the morphological CLS token, preventing catastrophic forgetting through DINO self-distillation and explicit feature anchoring to the frozen pretrained encoder. Gene expression regression at both spot-level (Visium) and patch-level (Xenium) resolutions provides complementary supervision across spatial scales. Trained on 577 publicly available HEST samples, MINT achieves the best overall performance on both HEST-Bench for gene expression prediction (mean Pearson r = 0.440) and EVA for general pathology tasks (0.803), demonstrating that spatial transcriptomics supervision complements morphology-centric self-supervised pretraining.

Spatial Transcriptomics (ST) profiles thousands of gene expression values at discrete spots with precise coordinates on tissue sections, preserving spatial context essential for clinical and pathological studies. With rising sequencing throughput and advancing platforms, the expanding data volumes motivate large-scale ST pretraining. However, the fundamental unit for pretraining, i.e., what constitutes a single training sample, remains ill-posed. Existing choices fall into two camps: (1) treating each spot as an independent sample, which discards spatial dependencies and collapses ST into single-cell transcriptomics; and (2) treating an entire slide as a single sample, which produces prohibitively large inputs and drastically fewer training examples, undermining effective pretraining. To address this gap, we propose treating spatial transcriptomics as croppable images. Specifically, we define a multi-channel image representation with fixed spatial size by cropping patches from raw slides, thereby preserving spatial context while substantially increasing the number of training samples. Along the channel dimension, we define gene subset selection rules to control input dimensionality and improve pretraining stability. Extensive experiments show that the proposed image-like dataset construction for ST pretraining consistently improves downstream performance, outperforming conventional pretraining schemes. Ablation studies verify that both spatial patching and channel design are necessary, establishing a unified, practical paradigm for organizing ST data and enabling large-scale pretraining.