# Thinking in Scales: Accelerating Gigapixel Pathology Image Analysis via Adaptive Continuous Reasoning

arXiv: https://arxiv.org/abs/2605.19491 · HTML: https://mlsanity.com/paper/2605.19491/

## Key facts

- Cited by 2 papers in the map (data through 14 Oct 2026).
- Builds on 23 of its 41 references that are in the map.
- First posted on arXiv 19 May 2026.

## 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)
- [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)
- [Multimodal Whole Slide Foundation Model for Pathology](https://mlsanity.com/paper/2411.19666/) (2024)
- [Liquid Time-constant Networks](https://mlsanity.com/paper/2006.04439/) (2020)
- [BRACS: A Dataset for BReAst Carcinoma Subtyping in H&E Histology Images](https://mlsanity.com/paper/2111.04740/) (2021)
- [PRISM: A Multi-Modal Generative Foundation Model for Slide-Level Histopathology](https://mlsanity.com/paper/2405.10254/) (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)
- [Differentiable Zooming for Multiple Instance Learning on Whole-Slide Images](https://mlsanity.com/paper/2204.12454/) (2022)
- [MedEyes: Learning Dynamic Visual Focus for Medical Progressive Diagnosis](https://mlsanity.com/paper/2511.22018/) (2025)
- [Diagnose Like a Pathologist: Transformer-Enabled Hierarchical Attention-Guided Multiple Instance Learning for Whole Slide Image Classification](https://mlsanity.com/paper/2301.08125/) (2023)
- [Continuous Thought Machines](https://mlsanity.com/paper/2505.05522/) (2025)
- [Pathology-Aware Prototype Evolution via LLM-Driven Semantic Disambiguation for Multicenter Diabetic Retinopathy Diagnosis](https://mlsanity.com/paper/2511.22033/) (2025)
- [MamBEV: Enabling State Space Models to Learn Birds-Eye-View Representations](https://mlsanity.com/paper/2503.13858/) (2025)
- [CARE: A Molecular-Guided Foundation Model with Adaptive Region Modeling for Whole Slide Image Analysis](https://mlsanity.com/paper/2602.21637/) (2026)
- [Fast and Accurate Gigapixel Pathological Image Classification with Hierarchical Distillation Multi-Instance Learning](https://mlsanity.com/paper/2502.21130/) (2025)
- [DRQA: Dynamic Reasoning Quota Allocation for Controlling Overthinking in Reasoning Large Language Models](https://mlsanity.com/paper/2508.17803/) (2025)
- [HAAF: Hierarchical Adaptation and Alignment of Foundation Models for Few-Shot Pathology Anomaly Detection](https://mlsanity.com/paper/2601.17405/) (2026)

## Built on by (most cited first, 2 of 2)

- [Modeling Whole-Slide Images as Dynamic Tumor Microenvironment Fields](https://mlsanity.com/paper/2609.34451/) (2026)
- [PlanPath: Exploration-Guided Orchestration for Patient-Level Pathology Reasoning](https://mlsanity.com/paper/2610.18664/) (2026)

## Abstract (arXiv)

Traditional whole slide image (WSI) analysis methods typically rely on the multiple instance learning (MIL) paradigm, which extracts patch-level features at high magnification and aggregates them for slide-level prediction. However, such exhaustive patch-level processing is computationally expensive, severely limiting the efficiency and scalability of WSI analysis. To address this challenge, we propose PathCTM (a Pathology-oriented Continuous Thought Model) that enables token-efficient scale-space continuous reasoning for gigapixel WSIs. PathCTM formulates diagnostic inference as a dynamic sequential information pursuit. It progressively transitions from low-magnification global to high-magnification local inspection, and adaptively terminates inference when sufficient evidence is gathered to effectively bound decision uncertainty. Specifically, it uses conditional computation for dynamic scale switching with attention-guided region pruning, coupled with confidence-aware early stopping. Extensive experiments demonstrate that, compared with standard MIL-based methods, PathCTM reduces the number of required image patches by 95.95% and shortens inference time by approximately 95.62%, while maintaining AUC without degradation. Code is available at https://github.com/JSGe-AI/PathCTM.