Libra-MIL: Multimodal Prototypes Stereoscopic Infused with Task-specific Language Priors for Few-shot Whole Slide Image Classification

While Large Language Models (LLMs) are emerging as a promising direction in computational pathology, the substantial computational cost of giga-pixel Whole Slide Images (WSIs) necessitates the use of Multi-Instance Learning (MIL) to enable effective modeling. A key challenge is that pathological tasks typically provide only bag-level labels, while instance-level descriptions generated by LLMs often suffer from bias due to a lack of fine-grained medical knowledge. To address this, we propose that constructing task-specific pathological entity prototypes is crucial for learning generalizable features and enhancing model interpretability. Furthermore, existing vision-language MIL methods often employ unidirectional guidance, limiting cross-modal synergy. In this paper, we introduce a novel approach, Multimodal Prototype-based Multi-Instance Learning, that promotes bidirectional interaction through a balanced information compression scheme. Specifically, we leverage a frozen LLM to generate task-specific pathological entity descriptions, which are learned as text prototypes. Concurrently, the vision branch learns instance-level prototypes to mitigate the model's reliance on redundant data. For the fusion stage, we employ the Stereoscopic Optimal Transport (SOT) algorithm, which is based on a similarity metric, thereby facilitating broader semantic alignment in a higher-dimensional space. We conduct few-shot classification and explainability experiments on three distinct cancer datasets, and the results demonstrate the superior generalization capabilities of our proposed method.

Zhenfeng Zhuang, Fangyu Zhou, Liansheng Wang · 2025