# Multi-level Multiple Instance Learning with Transformer for Whole Slide Image Classification

arXiv: https://arxiv.org/abs/2306.05029 · HTML: https://mlsanity.com/paper/2306.05029/

## Key facts

- Cited by 6 papers in the map (data through 14 Oct 2026).
- Builds on 34 of its 49 references that are in the map.
- First posted on arXiv 8 Jun 2023.

## Builds on (most cited first, 30 of 34)

- [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)
- [An Image is Worth 16x16 Words: Transformers for Image Recognition at Scale](https://mlsanity.com/paper/2010.11929/) (2020)
- [Swin Transformer: Hierarchical Vision Transformer using Shifted Windows](https://mlsanity.com/paper/2103.14030/) (2021)
- [EfficientNet: Rethinking Model Scaling for Convolutional Neural Networks](https://mlsanity.com/paper/1905.11946/) (2019)
- [Longformer: The Long-Document Transformer](https://mlsanity.com/paper/2004.05150/) (2020)
- [Non-local Neural Networks](https://mlsanity.com/paper/1711.07971/) (2017)
- [Big Bird: Transformers for Longer Sequences](https://mlsanity.com/paper/2007.14062/) (2020)
- [Reformer: The Efficient Transformer](https://mlsanity.com/paper/2001.04451/) (2020)
- [TransUNet: Transformers Make Strong Encoders for Medical Image Segmentation](https://mlsanity.com/paper/2102.04306/) (2021)
- [Generating Long Sequences with Sparse Transformers](https://mlsanity.com/paper/1904.10509/) (2019)
- [Linformer: Self-Attention with Linear Complexity](https://mlsanity.com/paper/2006.04768/) (2020)
- [Spatial Transformer Networks](https://mlsanity.com/paper/1506.02025/) (2015)
- [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)
- [CCNet: Criss-Cross Attention for Semantic Segmentation](https://mlsanity.com/paper/1811.11721/) (2018)
- [TransMIL: Transformer based Correlated Multiple Instance Learning for Whole Slide Image Classification](https://mlsanity.com/paper/2106.00908/) (2021)
- [Stand-Alone Self-Attention in Vision Models](https://mlsanity.com/paper/1906.05909/) (2019)
- [Dual-stream Multiple Instance Learning Network for Whole Slide Image Classification with Self-supervised Contrastive Learning](https://mlsanity.com/paper/2011.08939/) (2020)
- [Nystr"omformer: A Nystr"om-Based Algorithm for Approximating Self-Attention](https://mlsanity.com/paper/2102.03902/) (2021)
- [Exploring Self-attention for Image Recognition](https://mlsanity.com/paper/2004.13621/) (2020)
- [DTFD-MIL: Double-Tier Feature Distillation Multiple Instance Learning for Histopathology Whole Slide Image Classification](https://mlsanity.com/paper/2203.12081/) (2022)
- [Local Relation Networks for Image Recognition](https://mlsanity.com/paper/1904.11491/) (2019)
- [Deep neural network models for computational histopathology: A survey](https://mlsanity.com/paper/1912.12378/) (2019)
- [Revisiting Multiple Instance Neural Networks](https://mlsanity.com/paper/1610.02501/) (2016)
- [Interventional Bag Multi-Instance Learning On Whole-Slide Pathological Images](https://mlsanity.com/paper/2303.06873/) (2023)
- [Multi-scale Domain-adversarial Multiple-instance CNN for Cancer Subtype Classification with Unannotated Histopathological Images](https://mlsanity.com/paper/2001.01599/) (2020)
- [CAMEL: A Weakly Supervised Learning Framework for Histopathology Image Segmentation](https://mlsanity.com/paper/1908.10555/) (2019)
- [Weakly supervised multiple instance learning histopathological tumor segmentation](https://mlsanity.com/paper/2004.05024/) (2020)
- [MSG-Transformer: Exchanging Local Spatial Information by Manipulating Messenger Tokens](https://mlsanity.com/paper/2105.15168/) (2021)

## Built on by (most cited first, 6 of 6)

- [Dynamic Policy-Driven Adaptive Multi-Instance Learning for Whole Slide Image Classification](https://mlsanity.com/paper/2403.07939/) (2024)
- [Cross-Level Multi-Instance Distillation for Self-Supervised Fine-Grained Visual Categorization](https://mlsanity.com/paper/2401.08860/) (2024)
- [Multiple Instance Learning Framework with Masked Hard Instance Mining for Gigapixel Histopathology Image Analysis](https://mlsanity.com/paper/2509.11526/) (2025)
- [DeltaMIL: Gated Memory Integration for Efficient and Discriminative Whole Slide Image Analysis](https://mlsanity.com/paper/2512.19331/) (2025)
- [R'enyi Entropy: A New Token Pruning Metric for Vision Transformers](https://mlsanity.com/paper/2603.27900/) (2026)
- [Symb-xMIL: Symbolic Explanations for Multiple Instance Learning in Digital Pathology](https://mlsanity.com/paper/2606.06224/) (2026)

## Abstract (arXiv)

Whole slide image (WSI) refers to a type of high-resolution scanned tissue image, which is extensively employed in computer-assisted diagnosis (CAD). The extremely high resolution and limited availability of region-level annotations make employing deep learning methods for WSI-based digital diagnosis challenging. Recently integrating multiple instance learning (MIL) and Transformer for WSI analysis shows very promising results. However, designing effective Transformers for this weakly-supervised high-resolution image analysis is an underexplored yet important problem. In this paper, we propose a Multi-level MIL (MMIL) scheme by introducing a hierarchical structure to MIL, which enables efficient handling of MIL tasks involving a large number of instances. Based on MMIL, we instantiated MMIL-Transformer, an efficient Transformer model with windowed exact self-attention for large-scale MIL tasks. To validate its effectiveness, we conducted a set of experiments on WSI classification tasks, where MMIL-Transformer demonstrate superior performance compared to existing state-of-the-art methods, i.e., 96.80% test AUC and 97.67% test accuracy on the CAMELYON16 dataset, 99.04% test AUC and 94.37% test accuracy on the TCGA-NSCLC dataset, respectively. All code and pre-trained models are available at: https://github.com/hustvl/MMIL-Transformer