# Can We Simplify Slide-level Fine-tuning of Pathology Foundation Models?

arXiv: https://arxiv.org/abs/2502.20823 · HTML: https://mlsanity.com/paper/2502.20823/

## Key facts

- Cited by 3 papers in the map (data through 14 Oct 2026).
- Builds on 25 of its 40 references that are in the map.
- First posted on arXiv 28 Feb 2025.

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

- [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)
- [Scaling Vision Transformers to Gigapixel Images via Hierarchical Self-Supervised Learning](https://mlsanity.com/paper/2206.02647/) (2022)
- [DTFD-MIL: Double-Tier Feature Distillation Multiple Instance Learning for Histopathology Whole Slide Image Classification](https://mlsanity.com/paper/2203.12081/) (2022)
- [Quilt-1M: One Million Image-Text Pairs for Histopathology](https://mlsanity.com/paper/2306.11207/) (2023)
- [Multimodal Whole Slide Foundation Model for Pathology](https://mlsanity.com/paper/2411.19666/) (2024)
- [On the Challenges and Perspectives of Foundation Models for Medical Image Analysis](https://mlsanity.com/paper/2306.05705/) (2023)
- [BRACS: A Dataset for BReAst Carcinoma Subtyping in H&E Histology Images](https://mlsanity.com/paper/2111.04740/) (2021)
- [Artificial Intelligence for Digital and Computational Pathology](https://mlsanity.com/paper/2401.06148/) (2023)
- [A graph-transformer for whole slide image classification](https://mlsanity.com/paper/2205.09671/) (2022)
- [Morphological Prototyping for Unsupervised Slide Representation Learning in Computational Pathology](https://mlsanity.com/paper/2405.11643/) (2024)
- [Feature Re-Embedding: Towards Foundation Model-Level Performance in Computational Pathology](https://mlsanity.com/paper/2402.17228/) (2024)
- [Dynamic Graph Representation with Knowledge-aware Attention for Histopathology Whole Slide Image Analysis](https://mlsanity.com/paper/2403.07719/) (2024)
- [Attention-Challenging Multiple Instance Learning for Whole Slide Image Classification](https://mlsanity.com/paper/2311.07125/) (2023)
- [Molecular-driven Foundation Model for Oncologic Pathology](https://mlsanity.com/paper/2501.16652/) (2025)
- [Multistain Pretraining for Slide Representation Learning in Pathology](https://mlsanity.com/paper/2408.02859/) (2024)
- [HMIL: Hierarchical Multi-Instance Learning for Fine-Grained Whole Slide Image Classification](https://mlsanity.com/paper/2411.07660/) (2024)
- [Shapley Values-enabled Progressive Pseudo Bag Augmentation for Whole Slide Image Classification](https://mlsanity.com/paper/2312.05490/) (2023)
- [Agent Aggregator with Mask Denoise Mechanism for Histopathology Whole Slide Image Analysis](https://mlsanity.com/paper/2409.11664/) (2024)
- [HEROHE Challenge: assessing HER2 status in breast cancer without immunohistochemistry or in situ hybridization](https://mlsanity.com/paper/2111.04738/) (2021)
- [RetMIL: Retentive Multiple Instance Learning for Histopathological Whole Slide Image Classification](https://mlsanity.com/paper/2403.10858/) (2024)
- [Diagnostic Text-guided Representation Learning in Hierarchical Classification for Pathological Whole Slide Image](https://mlsanity.com/paper/2411.10709/) (2024)
- [Towards a Comprehensive Benchmark for Pathological Lymph Node Metastasis in Breast Cancer Sections](https://mlsanity.com/paper/2411.10752/) (2024)

## Built on by (most cited first, 3 of 3)

- [G2L:From Giga-Scale to Cancer-Specific Large-Scale Pathology Foundation Models via Knowledge Distillation](https://mlsanity.com/paper/2510.11176/) (2025)
- [Clinically-Informed Modeling for Pediatric Brain Tumor Classification from Whole-Slide Histopathology Images](https://mlsanity.com/paper/2604.21060/) (2026)
- [StainNet: Scaling Self-Supervised Foundation Models on Immunohistochemistry and Special Stains for Computational Pathology](https://mlsanity.com/paper/2512.10326/) (2025)

## Abstract (arXiv)

The emergence of foundation models in computational pathology has transformed histopathological image analysis, with whole slide imaging (WSI) diagnosis being a core application. Traditionally, weakly supervised fine-tuning via multiple instance learning (MIL) has been the primary method for adapting foundation models to WSIs. However, in this work we present a key experimental finding: a simple nonlinear mapping strategy combining mean pooling and a multilayer perceptron, called SiMLP, can effectively adapt patch-level foundation models to slide-level tasks without complex MIL-based learning. Through extensive experiments across diverse downstream tasks, we demonstrate the superior performance of SiMLP with state-of-the-art methods. For instance, on a large-scale pan-cancer classification task, SiMLP surpasses popular MIL-based methods by 3.52%. Furthermore, SiMLP shows strong learning ability in few-shot classification and remaining highly competitive with slide-level foundation models pretrained on tens of thousands of slides. Finally, SiMLP exhibits remarkable robustness and transferability in lung cancer subtyping. Overall, our findings challenge the conventional MIL-based fine-tuning paradigm, demonstrating that a task-agnostic representation strategy alone can effectively adapt foundation models to WSI analysis. These insights offer a unique and meaningful perspective for future research in digital pathology, paving the way for more efficient and broadly applicable methodologies.