# SAC-MIL: Spatial-Aware Correlated Multiple Instance Learning for Histopathology Whole Slide Image Classification

arXiv: https://arxiv.org/abs/2509.03973 · HTML: https://mlsanity.com/paper/2509.03973/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 46 of its 55 references that are in the map.
- First posted on arXiv 4 Sep 2025.

## Builds on (most cited first, 30 of 46)

- [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)
- [Mamba: Linear-Time Sequence Modeling with Selective State Spaces](https://mlsanity.com/paper/2312.00752/) (2023)
- [RoFormer: Enhanced Transformer with Rotary Position Embedding](https://mlsanity.com/paper/2104.09864/) (2021)
- [FlashAttention: Fast and Memory-Efficient Exact Attention with IO-Awareness](https://mlsanity.com/paper/2205.14135/) (2022)
- [Delving Deep into Rectifiers: Surpassing Human-Level Performance on ImageNet Classification](https://mlsanity.com/paper/1502.01852/) (2015)
- [Efficiently Modeling Long Sequences with Structured State Spaces](https://mlsanity.com/paper/2111.00396/) (2021)
- [Transformers are RNNs: Fast Autoregressive Transformers with Linear Attention](https://mlsanity.com/paper/2006.16236/) (2020)
- [Transformer-XL: Attentive Language Models Beyond a Fixed-Length Context](https://mlsanity.com/paper/1901.02860/) (2019)
- [Deformable Convolutional Networks](https://mlsanity.com/paper/1703.06211/) (2017)
- [MLP-Mixer: An all-MLP Architecture for Vision](https://mlsanity.com/paper/2105.01601/) (2021)
- [Self-Attention with Relative Position Representations](https://mlsanity.com/paper/1803.02155/) (2018)
- [Train Short, Test Long: Attention with Linear Biases Enables Input Length Extrapolation](https://mlsanity.com/paper/2108.12409/) (2021)
- [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)
- [Extending Context Window of Large Language Models via Positional Interpolation](https://mlsanity.com/paper/2306.15595/) (2023)
- [TransMIL: Transformer based Correlated Multiple Instance Learning for Whole Slide Image Classification](https://mlsanity.com/paper/2106.00908/) (2021)
- [MetaFormer Is Actually What You Need for Vision](https://mlsanity.com/paper/2111.11418/) (2021)
- [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)
- [Conditional Positional Encodings for Vision Transformers](https://mlsanity.com/paper/2102.10882/) (2021)
- [Pay Attention to MLPs](https://mlsanity.com/paper/2105.08050/) (2021)
- [Scaling Vision Transformers to Gigapixel Images via Hierarchical Self-Supervised Learning](https://mlsanity.com/paper/2206.02647/) (2022)
- [ResMLP: Feedforward networks for image classification with data-efficient training](https://mlsanity.com/paper/2105.03404/) (2021)
- [Unified-IO 2: Scaling Autoregressive Multimodal Models with Vision, Language, Audio, and Action](https://mlsanity.com/paper/2312.17172/) (2023)
- [Global Filter Networks for Image Classification](https://mlsanity.com/paper/2107.00645/) (2021)
- [DTFD-MIL: Double-Tier Feature Distillation Multiple Instance Learning for Histopathology Whole Slide Image Classification](https://mlsanity.com/paper/2203.12081/) (2022)
- [Rotary Position Embedding for Vision Transformer](https://mlsanity.com/paper/2403.13298/) (2024)
- [LongNet: Scaling Transformers to 1,000,000,000 Tokens](https://mlsanity.com/paper/2307.02486/) (2023)

## Abstract (arXiv)

We propose Spatial-Aware Correlated Multiple Instance Learning (SAC-MIL) for performing WSI classification. SAC-MIL consists of a positional encoding module to encode position information and a SAC block to perform full instance correlations. The positional encoding module utilizes the instance coordinates within the slide to encode the spatial relationships instead of the instance index in the input WSI sequence. The positional encoding module can also handle the length extrapolation issue where the training and testing sequences have different lengths. The SAC block is an MLP-based method that performs full instance correlation in linear time complexity with respect to the sequence length. Due to the simple structure of MLP, it is easy to deploy since it does not require custom CUDA kernels, compared to Transformer-based methods for WSI classification. SAC-MIL has achieved state-of-the-art performance on the CAMELYON-16, TCGA-LUNG, and TCGA-BRAC datasets. The code will be released upon acceptance.