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Main Authors: He, Dexuan, Zhou, Xiao, Guan, Wenbin, Zhang, Liyuan, Zhang, Xiaoman, Xu, Sinuo, Wang, Ge, Wang, Lifeng, Yuan, Xiaojun, Sun, Xin, Wang, Yanfeng, Sun, Kun, Zhang, Ya, Xie, Weidi
Format: Preprint
Published: 2025
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Online Access:https://arxiv.org/abs/2508.15904
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author He, Dexuan
Zhou, Xiao
Guan, Wenbin
Zhang, Liyuan
Zhang, Xiaoman
Xu, Sinuo
Wang, Ge
Wang, Lifeng
Yuan, Xiaojun
Sun, Xin
Wang, Yanfeng
Sun, Kun
Zhang, Ya
Xie, Weidi
author_facet He, Dexuan
Zhou, Xiao
Guan, Wenbin
Zhang, Liyuan
Zhang, Xiaoman
Xu, Sinuo
Wang, Ge
Wang, Lifeng
Yuan, Xiaojun
Sun, Xin
Wang, Yanfeng
Sun, Kun
Zhang, Ya
Xie, Weidi
contents Rare cancers comprise 20-25% of all malignancies but face major diagnostic challenges due to limited expert availability-especially in pediatric oncology, where they represent over 70% of cases. While pathology vision-language (VL) foundation models show promising zero-shot capabilities for common cancer subtyping, their clinical performance for rare cancers remains limited. Existing multi-instance learning (MIL) methods rely only on visual features, overlooking cross-modal knowledge and compromising interpretability critical for rare cancer diagnosis. To address this limitation, we propose PathPT, a novel framework that fully exploits the potential of vision-language pathology foundation models through spatially-aware visual aggregation and task-specific prompt tuning. Unlike conventional MIL, PathPT converts WSI-level supervision into fine-grained tile-level guidance by leveraging the zero-shot capabilities of VL models, thereby preserving localization on cancerous regions and enabling cross-modal reasoning through prompts aligned with histopathological semantics. We benchmark PathPT on eight rare cancer datasets(four adult and four pediatric) spanning 56 subtypes and 2,910 WSIs, as well as three common cancer datasets, evaluating four state-of-the-art VL models and four MIL frameworks under three few-shot settings. Results show that PathPT consistently delivers superior performance, achieving substantial gains in subtyping accuracy and cancerous region grounding ability. This work advances AI-assisted diagnosis for rare cancers, offering a scalable solution for improving subtyping accuracy in settings with limited access to specialized expertise.
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spellingShingle Boosting Pathology Foundation Models via Few-shot Prompt-tuning for Rare Cancer Subtyping
He, Dexuan
Zhou, Xiao
Guan, Wenbin
Zhang, Liyuan
Zhang, Xiaoman
Xu, Sinuo
Wang, Ge
Wang, Lifeng
Yuan, Xiaojun
Sun, Xin
Wang, Yanfeng
Sun, Kun
Zhang, Ya
Xie, Weidi
Computer Vision and Pattern Recognition
Rare cancers comprise 20-25% of all malignancies but face major diagnostic challenges due to limited expert availability-especially in pediatric oncology, where they represent over 70% of cases. While pathology vision-language (VL) foundation models show promising zero-shot capabilities for common cancer subtyping, their clinical performance for rare cancers remains limited. Existing multi-instance learning (MIL) methods rely only on visual features, overlooking cross-modal knowledge and compromising interpretability critical for rare cancer diagnosis. To address this limitation, we propose PathPT, a novel framework that fully exploits the potential of vision-language pathology foundation models through spatially-aware visual aggregation and task-specific prompt tuning. Unlike conventional MIL, PathPT converts WSI-level supervision into fine-grained tile-level guidance by leveraging the zero-shot capabilities of VL models, thereby preserving localization on cancerous regions and enabling cross-modal reasoning through prompts aligned with histopathological semantics. We benchmark PathPT on eight rare cancer datasets(four adult and four pediatric) spanning 56 subtypes and 2,910 WSIs, as well as three common cancer datasets, evaluating four state-of-the-art VL models and four MIL frameworks under three few-shot settings. Results show that PathPT consistently delivers superior performance, achieving substantial gains in subtyping accuracy and cancerous region grounding ability. This work advances AI-assisted diagnosis for rare cancers, offering a scalable solution for improving subtyping accuracy in settings with limited access to specialized expertise.
title Boosting Pathology Foundation Models via Few-shot Prompt-tuning for Rare Cancer Subtyping
topic Computer Vision and Pattern Recognition
url https://arxiv.org/abs/2508.15904