Experiments on WSI captioning, visual question answering, and slide-level classification tasks demonstrate that an 87M parameter LaGuadia student model matches or exceeds foundation-scale models such as GigaPath and UNI, achieving strong factual consistency and robust generalization.
Abstract
Pathology Foundation Models (PFMs) offer powerful Whole Slide Image (WSI) representations but suffer from massive computational costs. While Knowledge Distillation (KD) can create efficient student models, existing multi-teacher methods often use suboptimal uniform weighting that ignores tissue heterogeneity. We propose LaGuadia (Language-Guided Adaptive DistillAtion), a framework that develops a compact pathology image encoder by dynamically integrating expertise from multiple PFMs under clinical linguistic guidance. Our approach utilizes a multi-stage pipeline: first, extracting visually observable clinical keywords from pathology reports; second, aligning visual features with these keywords via a Vision-Language meta-teacher (MedSigLIP) to provide dense semantic guidance; and finally, performing adaptive KD where teacher contributions are weighted based on their semantic alignment with the clinical narrative. Experiments on WSI captioning, visual question answering, and slide-level classification tasks demonstrate that an 87M parameter LaGuadia student model matches or exceeds foundation-scale models such as GigaPath and UNI, achieving strong factual consistency and robust generalization. These results highlight clinical language as an effective semantic anchor for building efficient and reliable digital pathology systems. Code is available at https://github.com/hvcl/LaGuadia.
This work presents ALICE, a unified foundation model trained through multi-stage agglomerative distillation that sequentially distills eight vision-only, vision-language, and slide-level teacher models into dedicated modules of a single backbone for broad computational pathology applications.
Jiawen Li, Tian Guan, Huijuan Shi et al.· arXiv.org· 0 citations
The rapid advancement of vision-language models (VLMs) has accelerated progress in computational pathology; however, whole-slide image (WSI)-based pathology report generation remains limited by the scarcity of large-scale WSI--report datasets and the complexity of mapping spatially distributed visual patterns to structured clinical text. To address this, we introduce a clinically curated Pan-Asia WSI--report dataset of approximately 10,500 pairs from five institutions and establish the REG 2025 benchmark through a MICCAI challenge for systematic evaluation of multimodal models. We analyze submitted methods spanning pretrained VLMs, multiple-instance learning frameworks, hierarchical expert models, retrieval-augmented generation, and cross-modal Transformers. Rather than indicating that VLM use alone was sufficient for superior performance, the results suggest that top-performing methods benefited from structured report representations, hierarchical diagnostic decomposition, and effective multimodal grounding. We identify key limitations, including instability in quantitative attribute estimation (e.g., numeric hallucination) and a tendency toward diagnostic overspecification, with some errors resembling known diagnostic pitfalls in routine pathology. These findings establish REG 2025 as a benchmark for evaluating WSI-based structured report generation and vision-language understanding in computational pathology, providing insights for the design of clinically grounded multimodal pathology models.
Yu-Mi Lee, Harim Oh, Hyo-yun Kim et al.· 0 citations
PathVU is introduced, a vision-anchored benchmark for fine-grained and multiscale visual understanding in computational pathology that provides a reproducible basis for developing and evaluating pathology MLLMs with explicit multiscale visual understanding.
Zongyi Chen, Yuping Liang, Jie Lin et al.· arXiv.org· 2 citations
PRISM2 demonstrates how language-supervised pretraining provides a scalable, clinically grounded signal for generalizable pathology representations, bridging human diagnostic reasoning and foundation model performance.
E. Vorontsov, George Shaikovski, Adam Casson et al.· Nature Medicine· 3 citations
Many high-performing pathology tile encoders are now foundation models with hundreds of millions to over a billion parameters. Encoding and storing the thousands of tiles in each whole-slide image with such models is costly on commodity hardware, so compact encoders that retain useful downstream performance are a valuable alternative. We present DistillPath-KS16, which starts from the existing 22M kaiko ViT-S/16 encoder and improves it by distilling from released pathology encoders used as frozen teachers. The recipe reads only the teachers'final class and patch tokens and trains on 6,000 public slides, needing neither their DINO nor iBOT pretraining heads nor a billion-tile corpus, so it applies to any released encoder that exposes backbone tokens. We distill four teachers spanning 86M to 1.1B parameters into the same student. Every variant improves the kaiko baseline on all three benchmarks we use, EVA, HEST, and PLISM, and the strongest teacher is task-dependent. On the seven-task EVA mean, DistillPath-KS16-Virchow2 reaches $0.795$, within $0.015$ points of Virchow2, the top-scoring model in our evaluation, at about $29\times$ fewer parameters; it also scores above H0-mini and GPFM on this aggregate metric, though that advantage is task-concentrated rather than uniform. Because it remains a 22M ViT-S/16 with 384-dimensional features, DistillPath-KS16 runs more than $25\times$ faster than Virchow2. Code is available at https://github.com/RamonKaspar/DistillPath, and released model weights are available at https://huggingface.co/collections/RamonK/distillpath.
Ramon Kaspar, Andrey Ignatov, Valentina Boeva· 0 citations
Gigapixel Whole-Slide Images (WSIs) present a fundamental computational bottleneck for vision-language models (VLMs) due to extreme sequence lengths. Existing approaches predominantly rely on spatial sampling or training-free pruning, which risk diluting weak but informative signals, leading to the loss of critical diagnostic evidence due to the spatially diffuse nature of pathological cues. We reformulate WSI token pruning as a sequential selection process, enabling the model to autonomously learn an optimal routing strategy rather than relying on static heuristics. We herein propose a decoupled routing framework integrated as an active plugin into the fully pre-trained SlideChat base model, leaving both the slide encoder and large language model frozen. To provide continuous gradients for the non-differentiable pruning operation during training, we introduce PathSelect. PathSelect employs a variance-preserving noise gate to modulate each patch's information flow via a differentiable Soft Top-K operator, paired with a diagonal-attention Denoiser that recovers the perturbed representations without semantic leakage. At inference, the PathSelect module is entirely detached. Relying solely on the trained Scorer, a deterministic Hard Top-K operator executes adaptive, data-dependent trajectory termination, significantly accelerating downstream generative processing with exceptionally low sequential token selection latency. Driven by an empirical average of only 44.86 tokens under a maximum constraint of K = 128, our framework achieves 74.00% overall accuracy on SlideBench (TCGA), representing an approximate 36.6x spatial token reduction relative to the uncompressed baseline average while consistently outperforming sampling-based counterparts.
Jing-Zhi Chen, Lan He, Zehong Chen et al.· 1 citation
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