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Jan 13

Revisiting End-to-End Learning with Slide-level Supervision in Computational Pathology

Pre-trained encoders for offline feature extraction followed by multiple instance learning (MIL) aggregators have become the dominant paradigm in computational pathology (CPath), benefiting cancer diagnosis and prognosis. However, performance limitations arise from the absence of encoder fine-tuning for downstream tasks and disjoint optimization with MIL. While slide-level supervised end-to-end (E2E) learning is an intuitive solution to this issue, it faces challenges such as high computational demands and suboptimal results. These limitations motivate us to revisit E2E learning. We argue that prior work neglects inherent E2E optimization challenges, leading to performance disparities compared to traditional two-stage methods. In this paper, we pioneer the elucidation of optimization challenge caused by sparse-attention MIL and propose a novel MIL called ABMILX. It mitigates this problem through global correlation-based attention refinement and multi-head mechanisms. With the efficient multi-scale random patch sampling strategy, an E2E trained ResNet with ABMILX surpasses SOTA foundation models under the two-stage paradigm across multiple challenging benchmarks, while remaining computationally efficient (<10 RTX3090 hours). We show the potential of E2E learning in CPath and calls for greater research focus in this area. The code is https://github.com/DearCaat/E2E-WSI-ABMILX.

  • 7 authors
·
Jun 2, 2025 1

nnActive: A Framework for Evaluation of Active Learning in 3D Biomedical Segmentation

Semantic segmentation is crucial for various biomedical applications, yet its reliance on large annotated datasets presents a bottleneck due to the high cost and specialized expertise required for manual labeling. Active Learning (AL) aims to mitigate this challenge by querying only the most informative samples, thereby reducing annotation effort. However, in the domain of 3D biomedical imaging, there is no consensus on whether AL consistently outperforms Random sampling. Four evaluation pitfalls hinder the current methodological assessment. These are (1) restriction to too few datasets and annotation budgets, (2) using 2D models on 3D images without partial annotations, (3) Random baseline not being adapted to the task, and (4) measuring annotation cost only in voxels. In this work, we introduce nnActive, an open-source AL framework that overcomes these pitfalls by (1) means of a large scale study spanning four biomedical imaging datasets and three label regimes, (2) extending nnU-Net by using partial annotations for training with 3D patch-based query selection, (3) proposing Foreground Aware Random sampling strategies tackling the foreground-background class imbalance of medical images and (4) propose the foreground efficiency metric, which captures the low annotation cost of background-regions. We reveal the following findings: (A) while all AL methods outperform standard Random sampling, none reliably surpasses an improved Foreground Aware Random sampling; (B) benefits of AL depend on task specific parameters; (C) Predictive Entropy is overall the best performing AL method, but likely requires the most annotation effort; (D) AL performance can be improved with more compute intensive design choices. As a holistic, open-source framework, nnActive can serve as a catalyst for research and application of AL in 3D biomedical imaging. Code is at: https://github.com/MIC-DKFZ/nnActive

  • 9 authors
·
Nov 24, 2025