让AI像医生一样主动寻找病理切片中的关键证据。
Agentic Visual Reasoning in Whole-Slide Pathology Images via Active Perception

- 用强化学习训练智能导航,自动选重点观察区域。
- 零样本测试下癌症分型准确率达80.14%,诊断准确率82.9%。
- 适合需要可解释性推理的病理分析与医学AI研究者。
全幻灯片视觉推理需在十亿像素级病理切片中定位稀疏诊断证据,并跨尺度整合观察结果。现有方法或过度压缩图像块为全局表示,或依赖启发式区域选择的预训练视觉-语言模型,削弱预测与形态学的关联性,且缺乏病理科训练的观察策略。我们提出 AdaptivePath,一种基于主动感知的框架,将全幻灯片证据获取建模为序列决策过程。导航器从病理学家标注的异常数据中学习与问题无关的异常驱动导航策略,避免昂贵的问题定制轨迹标注。通过交替进行表征学习与近端策略优化训练,并结合几何与外观一致性目标微调,稳定关注轨迹。推理时,导航器在有限感兴趣区预算下,从低到高倍率分层获取稀疏观测。形态解释器将观测转化为条件化证据,评判者在多倍率间评估并修正中间答案。仲裁者融合推理历史生成最终答案。AdaptivePath 在全幻灯片与区域病理 VQA 基准上达到最先进零样本性能,六组 TCGA 数据集上癌症亚型分类准确率达 80.14%。盲法诊断效用研究显示,使用 AdaptivePath 选定观测序列的病理学家诊断准确率为 82.9%。结果表明,学习到的主动感知能实现高效且可追溯的超大尺寸病理图像视觉推理。
原文摘要 · Abstract (English)
Whole-slide visual reasoning requires identifying sparse diagnostic evidence in gigapixel pathology slides and integrating observations across spatial scales. Existing WSI methods either compress densely sampled patches into global representations or use pretrained vision-language models with heuristic region selection, weakening links between predictions and morphology or lacking pathology-trained observation policies. We present AdaptivePath, an active-perception framework that formulates WSI evidence acquisition as sequential decision making. The Navigator learns question-agnostic abnormality-driven navigation from pathologist-reviewed labels to select observation locations and spatial extents, avoiding costly question-specific trajectory annotations. We train this policy through alternating representation learning and proximal policy optimization, followed by fine-tuning with geometric and appearance consistency objectives to stabilize focus trajectories. During inference, the Navigator hierarchically acquires sparse observations from low to high magnification under a limited ROI budget. A Morphology Interpreter converts observations into question-conditioned evidence, while the Deliberator evaluates evidence and revises intermediate answers across magnifications. The Arbiter integrates deliberation history to produce final answers. AdaptivePath achieves state-of-the-art zero-shot performance on WSI and region pathology VQA benchmarks and reaches 80.14% accuracy for cancer subtype classification across six TCGA cohorts. In a blinded diagnostic-utility study, pathologists using AdaptivePath-selected observation sequences achieve 82.9% accuracy. These results demonstrate that learned active perception enables effective and traceable visual reasoning over gigapixel pathology slides.
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