# Attention2Minority: A salient instance inference-based multiple instance learning for classifying small lesions in whole slide images

arXiv: https://arxiv.org/abs/2301.07700 · HTML: https://mlsanity.com/paper/2301.07700/

## Key facts

- Cited by 5 papers in the map (data through 14 Oct 2026).
- Builds on 25 of its 53 references that are in the map.
- First posted on arXiv 18 Jan 2023.

## Builds on (most cited first, 25 of 25)

- [Attention Is All You Need](https://mlsanity.com/paper/1706.03762/) (2017)
- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [Adam: A Method for Stochastic Optimization](https://mlsanity.com/paper/1412.6980/) (2014)
- [An Image is Worth 16x16 Words: Transformers for Image Recognition at Scale](https://mlsanity.com/paper/2010.11929/) (2020)
- [Attention-based Deep Multiple Instance Learning](https://mlsanity.com/paper/1802.04712/) (2018)
- [Data Efficient and Weakly Supervised Computational Pathology on Whole Slide Images](https://mlsanity.com/paper/2004.09666/) (2020)
- [TransMIL: Transformer based Correlated Multiple Instance Learning for Whole Slide Image Classification](https://mlsanity.com/paper/2106.00908/) (2021)
- [Dual-stream Multiple Instance Learning Network for Whole Slide Image Classification with Self-supervised Contrastive Learning](https://mlsanity.com/paper/2011.08939/) (2020)
- [HoVer-Net: Simultaneous Segmentation and Classification of Nuclei in Multi-Tissue Histology Images](https://mlsanity.com/paper/1812.06499/) (2018)
- [Scaling Vision Transformers to Gigapixel Images via Hierarchical Self-Supervised Learning](https://mlsanity.com/paper/2206.02647/) (2022)
- [Recent Advances in Open Set Recognition: A Survey](https://mlsanity.com/paper/1811.08581/) (2018)
- [DTFD-MIL: Double-Tier Feature Distillation Multiple Instance Learning for Histopathology Whole Slide Image Classification](https://mlsanity.com/paper/2203.12081/) (2022)
- [Not-so-supervised: a survey of semi-supervised, multi-instance, and transfer learning in medical image analysis](https://mlsanity.com/paper/1804.06353/) (2018)
- [Open-World Semi-Supervised Learning](https://mlsanity.com/paper/2102.03526/) (2021)
- [Deep Learning for Anomaly Detection: A Review](https://mlsanity.com/paper/2007.02500/) (2020)
- [Revisiting Multiple Instance Neural Networks](https://mlsanity.com/paper/1610.02501/) (2016)
- [Catching Both Gray and Black Swans: Open-set Supervised Anomaly Detection](https://mlsanity.com/paper/2203.14506/) (2022)
- [Deep Learning for Identifying Metastatic Breast Cancer](https://mlsanity.com/paper/1606.05718/) (2016)
- [A Multi-resolution Model for Histopathology Image Classification and Localization with Multiple Instance Learning](https://mlsanity.com/paper/2011.02679/) (2020)
- [Classification and Disease Localization in Histopathology Using Only Global Labels: A Weakly-Supervised Approach](https://mlsanity.com/paper/1802.02212/) (2018)
- [Accounting for Dependencies in Deep Learning Based Multiple Instance Learning for Whole Slide Imaging](https://mlsanity.com/paper/2111.01556/) (2021)
- [RMDL: Recalibrated multi-instance deep learning for whole slide gastric image classification](https://mlsanity.com/paper/2010.06440/) (2020)
- [A novel multiple instance learning framework for COVID-19 severity assessment via data augmentation and self-supervised learning](https://mlsanity.com/paper/2102.03837/) (2021)
- [Self-Supervised Equivariant Regularization Reconciles Multiple Instance Learning: Joint Referable Diabetic Retinopathy Classification and Lesion Segmentation](https://mlsanity.com/paper/2210.05946/) (2022)
- [Localization of Critical Findings in Chest X-Ray without Local Annotations Using Multi-Instance Learning](https://mlsanity.com/paper/2001.08817/) (2020)

## Built on by (most cited first, 5 of 5)

- [Computational Pathology for Accurate Prediction of Breast Cancer Recurrence: Development and Validation of a Deep Learning-based Tool](https://mlsanity.com/paper/2409.15491/) (2024)
- [Learning the Language of Histopathology Images reveals Prognostic Subgroups in Invasive Lung Adenocarcinoma Patients](https://mlsanity.com/paper/2508.16742/) (2025)
- [Machine Learning Based Analytics for the Significance of Gait Analysis in Monitoring and Managing Lower Extremity Injuries](https://mlsanity.com/paper/2309.15990/) (2023)
- [PathoScribe: Transforming Pathology Data into a Living Library with a Unified LLM-Driven Framework for Semantic Retrieval and Clinical Integration](https://mlsanity.com/paper/2603.08935/) (2026)
- [Representation Transfer of Foundation Models for Ultra-Widefield Retinal Imaging](https://mlsanity.com/paper/2608.00586/) (2026)

## Abstract (arXiv)

Multiple instance learning (MIL) models have achieved remarkable success in analyzing whole slide images (WSIs) for disease classification problems. However, with regard to gigapixel WSI classification problems, current MIL models are often incapable of differentiating a WSI with extremely small tumor lesions. This minute tumor-to-normal area ratio in a MIL bag inhibits the attention mechanism from properly weighting the areas corresponding to minor tumor lesions. To overcome this challenge, we propose salient instance inference MIL (SiiMIL), a weakly-supervised MIL model for WSI classification. Our method initially learns representations of normal WSIs, and it then compares the normal WSIs representations with all the input patches to infer the salient instances of the input WSI. Finally, it employs attention-based MIL to perform the slide-level classification based on the selected patches of the WSI. Our experiments imply that SiiMIL can accurately identify tumor instances, which could only take up less than 1% of a WSI, so that the ratio of tumor to normal instances within a bag can increase by two to four times. It is worth mentioning that it performs equally well for large tumor lesions. As a result, SiiMIL achieves a significant improvement in performance over the state-of-the-art MIL methods.