# Accurate and Scalable Multimodal Pathology Retrieval via Attentive Vision-Language Alignment

arXiv: https://arxiv.org/abs/2510.23224 · HTML: https://mlsanity.com/paper/2510.23224/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 25 of its 56 references that are in the map.
- First posted on arXiv 27 Oct 2025.

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

- [Learning Transferable Visual Models From Natural Language Supervision](https://mlsanity.com/paper/2103.00020/) (2021)
- [Qwen3 Technical Report](https://mlsanity.com/paper/2505.09388/) (2025)
- [Representation Learning with Contrastive Predictive Coding](https://mlsanity.com/paper/1807.03748/) (2018)
- [Domain-Specific Language Model Pretraining for Biomedical Natural Language Processing](https://mlsanity.com/paper/2007.15779/) (2020)
- [TransMIL: Transformer based Correlated Multiple Instance Learning for Whole Slide Image Classification](https://mlsanity.com/paper/2106.00908/) (2021)
- [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)
- [Multimodal Whole Slide Foundation Model for Pathology](https://mlsanity.com/paper/2411.19666/) (2024)
- [BRACS: A Dataset for BReAst Carcinoma Subtyping in H&E Histology Images](https://mlsanity.com/paper/2111.04740/) (2021)
- [Human-Centered Tools for Coping with Imperfect Algorithms during Medical Decision-Making](https://mlsanity.com/paper/1902.02960/) (2019)
- [Deep Learning-based Computational Pathology Predicts Origins for Cancers of Unknown Primary](https://mlsanity.com/paper/2006.13932/) (2020)
- [PRISM: A Multi-Modal Generative Foundation Model for Slide-Level Histopathology](https://mlsanity.com/paper/2405.10254/) (2024)
- [Foundation Model for Advancing Healthcare: Challenges, Opportunities, and Future Directions](https://mlsanity.com/paper/2404.03264/) (2024)
- [A Multimodal Knowledge-enhanced Whole-slide Pathology Foundation Model](https://mlsanity.com/paper/2407.15362/) (2024)
- [Deep Learning for Whole Slide Image Analysis: An Overview](https://mlsanity.com/paper/1910.11097/) (2019)
- [Pathologist-level classification of histologic patterns on resected lung adenocarcinoma slides with deep neural networks](https://mlsanity.com/paper/1901.11489/) (2019)
- [Yottixel -- An Image Search Engine for Large Archives of Histopathology Whole Slide Images](https://mlsanity.com/paper/1911.08748/) (2019)
- [Domain Generalization in Computational Pathology: Survey and Guidelines](https://mlsanity.com/paper/2310.19656/) (2023)
- [Self-eXplainable AI for Medical Image Analysis: A Survey and New Outlooks](https://mlsanity.com/paper/2410.02331/) (2024)
- [Dynamic Weighted Combiner for Mixed-Modal Image Retrieval](https://mlsanity.com/paper/2312.06179/) (2023)
- [PRISM2: Unlocking Multi-Modal General Pathology AI with Clinical Dialogue](https://mlsanity.com/paper/2506.13063/) (2025)
- [Analysis and Validation of Image Search Engines in Histopathology](https://mlsanity.com/paper/2401.03271/) (2024)
- [Language Guided Local Infiltration for Interactive Image Retrieval](https://mlsanity.com/paper/2304.07747/) (2023)
- [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)
- [On Validation of Search & Retrieval of Tissue Images in Digital Pathology](https://mlsanity.com/paper/2408.01570/) (2024)

## Abstract (arXiv)

The rapid digitization of histopathology slides has opened new opportunities for computational tools in clinical and research workflows. Content-based slide retrieval can help pathologists identify morphologically and semantically related precedent cases, supporting expert diagnosis and example-based education. Effective retrieval of whole-slide images (WSIs), however, remains challenging because gigapixel slides contain abundant irrelevant content, focal diagnostic patterns and slide-level semantic information that must be represented at a practicable search cost. Here we present PathSearch, a retrieval framework that combines fine-grained attentive mosaics with slide-level embeddings aligned through vision-language contrastive learning. Trained on 6,926 slide-report pairs, PathSearch captures both fine-grained morphological cues and high-level semantic patterns to enable accurate and flexible retrieval. The framework supports two key functionalities: (1) mosaic-based image-to-image (I2I) retrieval, ensuring accurate and efficient slide search; and (2) multimodal retrieval, where text queries can directly retrieve relevant slides. PathSearch was evaluated on eight tasks comprising 5,021 evaluation slides, spanning malignancy assessment on frozen and hematoxylin and eosin (H&E)-stained slides, lymph-node metastasis detection, tumor subtyping, mixed-gallery rare-cancer retrieval, and hepatocellular carcinoma (HCC) risk stratification. Internal and external experimental results demonstrate that PathSearch consistently outperforms the strongest existing methods without compromising multimodal accuracy. A multi-center reader study further demonstrated increases in task-level mean diagnostic accuracy, confidence, and inter-observer agreement with PathSearch's support. Together, these results support the effectiveness of PathSearch across diverse retrieval tasks and evaluation settings.