# Beyond Sparse Captions: Aligning Slide-Level Text and Patch-Level Vision in Pathology

arXiv: https://arxiv.org/abs/2610.17233 · HTML: https://mlsanity.com/paper/2610.17233/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 30 of its 42 references that are in the map.
- First posted on arXiv 12 Oct 2026.

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

- [Learning Transferable Visual Models From Natural Language Supervision](https://mlsanity.com/paper/2103.00020/) (2021)
- [LoRA: Low-Rank Adaptation of Large Language Models](https://mlsanity.com/paper/2106.09685/) (2021)
- [BLIP-2: Bootstrapping Language-Image Pre-training with Frozen Image Encoders and Large Language Models](https://mlsanity.com/paper/2301.12597/) (2023)
- [Sigmoid Loss for Language Image Pre-Training](https://mlsanity.com/paper/2303.15343/) (2023)
- [CoCa: Contrastive Captioners are Image-Text Foundation Models](https://mlsanity.com/paper/2205.01917/) (2022)
- [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)
- [LiT: Zero-Shot Transfer with Locked-image text Tuning](https://mlsanity.com/paper/2111.07991/) (2021)
- [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)
- [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)
- [Visual Language Pretrained Multiple Instance Zero-Shot Transfer for Histopathology Images](https://mlsanity.com/paper/2306.07831/) (2023)
- [X-Pool: Cross-Modal Language-Video Attention for Text-Video Retrieval](https://mlsanity.com/paper/2203.15086/) (2022)
- [Artificial Intelligence for Digital and Computational Pathology](https://mlsanity.com/paper/2401.06148/) (2023)
- [Virchow: A Million-Slide Digital Pathology Foundation Model](https://mlsanity.com/paper/2309.07778/) (2023)
- [PRISM: A Multi-Modal Generative Foundation Model for Slide-Level Histopathology](https://mlsanity.com/paper/2405.10254/) (2024)
- [Dynamic Graph Representation with Knowledge-aware Attention for Histopathology Whole Slide Image Analysis](https://mlsanity.com/paper/2403.07719/) (2024)
- [Accelerating Data Processing and Benchmarking of AI Models for Pathology](https://mlsanity.com/paper/2502.06750/) (2025)
- [SlideChat: A Large Vision-Language Assistant for Whole-Slide Pathology Image Understanding](https://mlsanity.com/paper/2410.11761/) (2024)
- [WSI-LLaVA: A Multimodal Large Language Model for Whole Slide Image](https://mlsanity.com/paper/2412.02141/) (2024)
- [PathAlign: A vision-language model for whole slide images in histopathology](https://mlsanity.com/paper/2406.19578/) (2024)
- [Do Multiple Instance Learning Models Transfer?](https://mlsanity.com/paper/2506.09022/) (2025)
- [Pan-tumor CAnine cuTaneous Cancer Histology (CATCH) dataset](https://mlsanity.com/paper/2201.11446/) (2022)
- [HISTAI: An Open-Source, Large-Scale Whole Slide Image Dataset for Computational Pathology](https://mlsanity.com/paper/2505.12120/) (2025)
- [SPIDER: A Comprehensive Multi-Organ Supervised Pathology Dataset and Baseline Models](https://mlsanity.com/paper/2503.02876/) (2025)
- [TICON: A Slide-Level Tile Contextualizer for Histopathology Representation Learning](https://mlsanity.com/paper/2512.21331/) (2025)
- [Act Like a Pathologist: Tissue-Aware Whole Slide Image Reasoning](https://mlsanity.com/paper/2603.00667/) (2026)
- [Mixture of Mini Experts: Overcoming the Linear Layer Bottleneck in Multiple Instance Learning](https://mlsanity.com/paper/2603.22198/) (2026)
- [Investigating Zero-Shot Diagnostic Pathology in Vision-Language Models with Efficient Prompt Design](https://mlsanity.com/paper/2505.00134/) (2025)

## Abstract (arXiv)

Contrastive vision-language (VL) pretraining in computational pathology has generally relied on curated image-caption datasets sourced from social media, educational videos, and research publications. These corpora are sparse relative to the diversity of tissue morphology and difficult to scale further, as pathologists do not routinely produce descriptive captions in clinical practice. We propose to instead leverage slide-level pathology reports which can be generated during routine diagnostic workflows in a scalable manner. A key challenge in this weakly-supervised setting is that pathology reports describe macroscopic, diagnostic findings while patch-level visual features describe microscopic findings. We introduce Locked Image Multiple Instance PreTraining (LIMIT), which addresses this gap by freezing a pretrained vision encoder and fine-tuning only the text encoder: report embeddings serve as cross-attention queries over bags of patch features, producing report-conditioned slide representations optimized via InfoNCE. Using LIMIT, we establish CONCH-Z, which aligns the text encoder of CONCH v1.5 to 335k clinical reports. Evaluated across 22 tasks spanning patch-level classification, tumor detection, and slide-level subtyping, CONCH-Z establishes state-of-the-art zero-shot performance over VL encoders trained on curated caption datasets, while simultaneously closing the gap with slide-level foundation models trained with substantially more parameters and compute. The code and model is available at https://github.com/mahmoodlab/LIMIT.