# MamMIL: Multiple Instance Learning for Whole Slide Images with State Space Models

arXiv: https://arxiv.org/abs/2403.05160 · HTML: https://mlsanity.com/paper/2403.05160/

## Key facts

- Cited by 12 papers in the map (data through 14 Oct 2026).
- Placed in Mamba for medical image analysis, one of 10 directions in State-space sequence models (S4, Mamba).
- Builds on 23 of its 35 references that are in the map.
- First posted on arXiv 8 Mar 2024.

## Placed in

- State-space sequence models (S4, Mamba) / [Mamba for medical image analysis](https://mlsanity.com/ssm/mamba-for-medical-image-analysis/)

## Builds on (most cited first, 23 of 23)

- [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)
- [Mamba: Linear-Time Sequence Modeling with Selective State Spaces](https://mlsanity.com/paper/2312.00752/) (2023)
- [Attention-based Deep Multiple Instance Learning](https://mlsanity.com/paper/1802.04712/) (2018)
- [Vision Mamba: Efficient Visual Representation Learning with Bidirectional State Space Model](https://mlsanity.com/paper/2401.09417/) (2024)
- [VMamba: Visual State Space Model](https://mlsanity.com/paper/2401.10166/) (2024)
- [On the Variance of the Adaptive Learning Rate and Beyond](https://mlsanity.com/paper/1908.03265/) (2019)
- [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)
- [Measuring and Relieving the Over-smoothing Problem for Graph Neural Networks from the Topological View](https://mlsanity.com/paper/1909.03211/) (2019)
- [DeepGCNs: Can GCNs Go as Deep as CNNs?](https://mlsanity.com/paper/1904.03751/) (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)
- [On the Parameterization and Initialization of Diagonal State Space Models](https://mlsanity.com/paper/2206.11893/) (2022)
- [VM-UNet: Vision Mamba UNet for Medical Image Segmentation](https://mlsanity.com/paper/2402.02491/) (2024)
- [DTFD-MIL: Double-Tier Feature Distillation Multiple Instance Learning for Histopathology Whole Slide Image Classification](https://mlsanity.com/paper/2203.12081/) (2022)
- [On The Computational Complexity of Self-Attention](https://mlsanity.com/paper/2209.04881/) (2022)
- [BRACS: A Dataset for BReAst Carcinoma Subtyping in H&E Histology Images](https://mlsanity.com/paper/2111.04740/) (2021)
- [Whole Slide Images are 2D Point Clouds: Context-Aware Survival Prediction using Patch-based Graph Convolutional Networks](https://mlsanity.com/paper/2107.13048/) (2021)
- [Artificial Intelligence for Digital and Computational Pathology](https://mlsanity.com/paper/2401.06148/) (2023)
- [Multiple Instance Learning for Digital Pathology: A Review on the State-of-the-Art, Limitations & Future Potential](https://mlsanity.com/paper/2206.04425/) (2022)
- [Structured State Space Models for Multiple Instance Learning in Digital Pathology](https://mlsanity.com/paper/2306.15789/) (2023)
- [DGMIL: Distribution Guided Multiple Instance Learning for Whole Slide Image Classification](https://mlsanity.com/paper/2206.08861/) (2022)

## Built on by (most cited first, 12 of 12)

- [State Space Model for New-Generation Network Alternative to Transformers: A Survey](https://mlsanity.com/paper/2404.09516/) (2024)
- [Vision Mamba: A Comprehensive Survey and Taxonomy](https://mlsanity.com/paper/2405.04404/) (2024)
- [Vim4Path: Self-Supervised Vision Mamba for Histopathology Images](https://mlsanity.com/paper/2404.13222/) (2024)
- [Mamba in Vision: A Comprehensive Survey of Techniques and Applications](https://mlsanity.com/paper/2410.03105/) (2024)
- [A Comprehensive Survey of Mamba Architectures for Medical Image Analysis: Classification, Segmentation, Restoration and Beyond](https://mlsanity.com/paper/2410.02362/) (2024)
- [Mamba2MIL: State Space Duality Based Multiple Instance Learning for Computational Pathology](https://mlsanity.com/paper/2408.15032/) (2024)
- [MambaMIL+: Modeling Long-Term Contextual Patterns for Gigapixel Whole Slide Image](https://mlsanity.com/paper/2512.17726/) (2025)
- [MsaMIL-Net: An End-to-End Multi-Scale Aware Multiple Instance Learning Network for Efficient Whole Slide Image Classification](https://mlsanity.com/paper/2503.08581/) (2025)
- [SemaMIL: Semantic-Aware Multiple Instance Learning with Retrieval-Guided State Space Modeling for Whole Slide Images](https://mlsanity.com/paper/2509.00442/) (2025)
- [CAPRMIL: Context-Aware Patch Representations for Multiple Instance Learning](https://mlsanity.com/paper/2512.14540/) (2025)
- [Geometry-Aware State Space Model: A New Paradigm for Whole-Slide Image Representation](https://mlsanity.com/paper/2605.05164/) (2026)
- [Graph Mamba Survival Analysis Based on Topology-Aware ordering](https://mlsanity.com/paper/2606.02602/) (2026)

## Abstract (arXiv)

Recently, pathological diagnosis has achieved superior performance by combining deep learning models with the multiple instance learning (MIL) framework using whole slide images (WSIs). However, the giga-pixeled nature of WSIs poses a great challenge for efficient MIL. Existing studies either do not consider global dependencies among instances, or use approximations such as linear attentions to model the pair-to-pair instance interactions, which inevitably brings performance bottlenecks. To tackle this challenge, we propose a framework named MamMIL for WSI analysis by cooperating the selective structured state space model (i.e., Mamba) with MIL, enabling the modeling of global instance dependencies while maintaining linear complexity. Specifically, considering the irregularity of the tissue regions in WSIs, we represent each WSI as an undirected graph. To address the problem that Mamba can only process 1D sequences, we further propose a topology-aware scanning mechanism to serialize the WSI graphs while preserving the topological relationships among the instances. Finally, in order to further perceive the topological structures among the instances and incorporate short-range feature interactions, we propose an instance aggregation block based on graph neural networks. Experiments show that MamMIL can achieve advanced performance than the state-of-the-art frameworks. The code can be accessed at https://github.com/Vison307/MamMIL.