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arXiv · 2604.22846

Unified Multi-Foundation-Model Slide Representation for Pan-Cancer Recognition and Text-Guided Tumor Localization

Tianyang Wang·Ziyu Su·Abdul Rehman Akbar·Usama Sajjad·Lina Gokhale·Charles Rabolli·Wei Chen·Anil Parwani·Muhammad Khalid Khan Niazi
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Abstract

The expanding ecosystem of pathology foundation models has produced powerful but fragmented tile-level representations, limiting their use in clinical tasks that require unified slide-level reasoning and interpretable linkage to clinically meaningful information. We present ASTRA, a pan-cancer framework that integrates heterogeneous foundation-model representations into a shared slide-level representation space and semantically grounds that space using structured pathology annotation fields, including classification category, cancer type, and anatomic site. ASTRA combines sparse mixture-of-experts contextualization, masked multi-model reconstruction, and contrastive alignment to structured pathology prompts to learn slide representations that support 4-category classification, 3-class solid tumor typing, 16-class cancer typing, and text-guided tumor localization without pixel-level supervision. Developed on a CHTN cohort of 10,359 whole-slide images (WSIs) spanning 16 tumor types, ASTRA consistently improves pan-cancer classification across four pathology foundation-model backbones, achieving up to 97.8% macro-AUC for 4-category classification, 99.7% for 3-class solid tumor typing, and 99.2% for 16-class cancer typing. For tumor localization, ASTRA achieves a mean Dice of 0.897 on an annotated in-domain CHTN subset (n = 380) spanning 16 cancer types and 0.738 on an external TCGA cohort (n = 1,686) spanning four cancer types. These results demonstrate that minimal structured pathology annotation fields derived from slide-level metadata can provide effective semantic supervision for unified slide representation learning, enabling both pan-cancer prediction and weakly supervised tumor localization within a single framework.

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Tianyang Wang, Ziyu Su, Abdul Rehman Akbar, Usama Sajjad, Lina Gokhale, Charles Rabolli, Wei Chen, Anil Parwani, Muhammad Khalid Khan Niazi. 2026-04-21. Unified Multi-Foundation-Model Slide Representation for Pan-Cancer Recognition and Text-Guided Tumor Localization. https://arxiv.org/abs/2604.22846

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