AutoMIL: Automated Multiple Instance Learning for Whole-Slide Image Classification

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.

Attention-based multiple instance learning (MIL) has emerged as a powerful framework for whole slide image (WSI) diagnosis, leveraging attention to aggregate instance-level features into bag-level predictions. Despite this success, we find that such methods exhibit a new failure mode: unstable attention dynamics. Across four representative attention-based MIL methods and two public WSI datasets, we observe that attention distributions oscillate across epochs rather than converging to a consistent pattern, degrading performance. This instability adds to two previously reported challenges: overfitting and over-concentrated attention distribution. To simultaneously overcome these three limitations, we introduce attention-stabilized multiple instance learning (ASMIL), a novel unified framework. ASMIL uses an anchor model to stabilize attention, replaces softmax with a normalized sigmoid function in the anchor to prevent over-concentration, and applies token random dropping to mitigate overfitting. Extensive experiments demonstrate that ASMIL achieves up to a 6.49% F1 score improvement over state-of-the-art methods. Moreover, integrating the anchor model and normalized sigmoid into existing attention-based MIL methods consistently boosts their performance, with F1 score gains up to 10.73%. All code and data are publicly available at https://github.com/Linfeng-Ye/ASMIL.

Multiple instance learning (MIL) has become a standard paradigm for whole slide image (WSI) analysis in digital pathology, as it enables slide-level prediction without dense annotations. Existing MIL methods typically rely on exhaustive extraction and encoding of high-resolution patches. However, this practice suffers from two critical limitations in real-world clinical settings: it struggles to capture global visual cues at lower magnifications, and incurs substantial computational overhead due to the massive number of high-resolution patches per slide. To address these limitations, we propose an efficient low-resolution multiple instance learning (LRMIL) framework that transfers high-resolution knowledge to low-resolution representations. LRMIL adopts a two-stage distillation strategy. First, patch-level cross-resolution distillation aligns low-resolution patch embeddings with high-resolution representations. Second, slide-level knowledge distillation trains a low-resolution student MIL model under both slide-level supervision and teacher guidance. At inference time, LRMIL operates exclusively on low-resolution patches, substantially reducing data preprocessing and computational cost. Extensive experiments on multiple WSI benchmarks demonstrate that LRMIL consistently outperforms state-of-the-art MIL methods while achieving more efficient inference. These results highlight LRMIL as a practical and scalable solution for WSI analysis in clinical pathology.