arXiv subjects

Lukas Ruff

Publications and source records attributed to Lukas Ruff.

At least 19 recordsLinked to original sources

arXiv2026

LUCAID: Agentic Multimodal AI for Lung Cancer Precision Pathology

Lung cancer tissue diagnostics is complex, as therapy decisions in precision oncology rely on the integration of histomorphological, immunohistochemical, and molecular features. Yet pathological assessment remains largely visual and semi-quantitative and shows interobserver variability, while existing artificial intelligence (AI) tools cover only selected tasks, rarely reach generalizable expert-level performance, and lack prospective clinical validation. To address these challenges, we developed and clinically validated LUCAID, an agentic AI system for precision lung cancer pathology. An integrative agent couples diagnostic reasoning with nine modules that cover the full routine workflow, from quality control, tumor detection and segmentation, histological subtyping, tumor microenvironment profiling, tumor cellularity quantification, and predictive biomarker scoring (PD-L1, MET, TROP-2) to automated structured report generation. LUCAID enables users to interactively query the module outputs and generate reports that contextualize the results. Against large-scale expert ground-truth annotations, the analysis modules achieved F1 scores of 0.82-0.95. In prospective clinical validation, LUCAID reached 93.0% concordance with an expert-panel adjudicated reference standard across clinically actionable decisions, compared with 68.3-81.1% for five experienced thoracic pathologists.

cs.CV↗

arXiv2026

Atlas H&E-TME: Scalable AI-Based Tissue Profiling at Expert Pathologist-Level Accuracy

Hematoxylin and eosin (H&E) staining is the cornerstone of histopathology, yet scalable, quantitative analysis of H&E whole-slide images (WSIs) remains a central challenge in computational pathology. We present Atlas H&E-TME, an AI-based system built on the Atlas family of pathology foundation models that predicts tissue quality, tissue region, and cell type labels across multiple cancer types, yielding over 4,500 quantitative readouts per slide at cell-level resolution. A key challenge to validating such systems is overcoming morphological ambiguity inherent to H&E-only ground truth and the limited scalability of more informed references drawing on modalities such as immunohistochemistry (IHC). We address this with a dual validation framework combining biologically grounded depth with technical and morphological breadth. For depth, we propose an IHC-informed multi-pathologist consensus protocol that substantially improves inter-rater agreement over conventional H&E-only annotation. This yields a molecularly grounded reference against which we compare Atlas H&E-TME and pathologists working from H&E alone. For breadth, we benchmark Atlas H&E-TME on over 200,000 high-confidence H&E-only pathologist annotations across 1,500+ cases spanning eight cancer types and their most common metastatic sites, with subtypes covering >90% of clinical cases per cancer type, drawn from 25+ sources and 8+ scanner models. Benchmarked against the IHC-informed consensus, Atlas H&E-TME matches or exceeds pathologist H&E-only performance and generalizes consistently and robustly across this broad morphological and technical scope. In doing so, Atlas H&E-TME turns the H&E slide -- the most ubiquitous data in pathology -- into a scalable, quantitative window into the tumor and its microenvironment, laying a foundation for the next generation of tissue-based biomarkers in translational and clinical research.

cs.CV↗

arXiv2026

OpenTME: An Open Dataset of AI-powered H&E Tumor Microenvironment Profiles from TCGA

The tumor microenvironment (TME) plays a central role in cancer progression, treatment response, and patient outcomes, yet large-scale, consistent, and quantitative TME characterization from routine hematoxylin and eosin (H&E)-stained histopathology remains scarce. We introduce OpenTME, an open-access dataset of pre-computed TME profiles derived from 3,634 H&E-stained whole-slide images across five cancer types (bladder, breast, colorectal, liver, and lung cancer) from The Cancer Genome Atlas (TCGA). All outputs were generated using Atlas H&E-TME, an AI-powered application built on the Atlas family of pathology foundation models, which performs tissue quality control, tissue segmentation, cell detection and classification, and spatial neighborhood analysis, yielding over 4,500 quantitative readouts per slide at cell-level resolution. OpenTME is available for non-commercial academic research on Hugging Face. We will continue to expand OpenTME over time and anticipate it will serve as a resource for biomarker discovery, spatial biology research, and the development of computational methods for TME analysis.

cs.CV↗

arXiv2026

Atlas 2 -- Foundation models for clinical deployment

Pathology foundation models substantially advanced the possibilities in computational pathology --- yet tradeoffs in terms of performance, robustness, and computational requirements remained, which limited their clinical deployment. In this report, we present Atlas 2, Atlas 2-B, and Atlas 2-S, three pathology vision foundation models which bridge these shortcomings by showing state-of-the-art prediction performance, robustness, and resource efficiency in a comprehensive evaluation across eighty public benchmarks. Our models were trained on the largest pathology foundation model dataset to date comprising 5.5 million histopathology whole slide images, collected from three medical institutions Charit\'e - Universit\"atsmedizin Berlin, LMU Munich, and Mayo Clinic.

cs.CV↗

arXiv2026

Mind the Gap: Continuous Magnification Sampling for Pathology Foundation Models

In histopathology, pathologists examine both tissue architecture at low magnification and fine-grained morphology at high magnification. Yet, the performance of pathology foundation models across magnifications and the effect of magnification sampling during training remain poorly understood. We model magnification sampling as a multi-source domain adaptation problem and develop a simple theoretical framework that reveals systematic trade-offs between sampling strategies. We show that the widely used discrete uniform sampling of magnifications (0.25, 0.5, 1.0, 2.0 mpp) leads to degradation at intermediate magnifications. We introduce continuous magnification sampling, which removes gaps in magnification coverage while preserving performance at standard scales. Further, we derive sampling distributions that optimize representation quality across magnification scales. To evaluate these strategies, we introduce two new benchmarks (TCGA-MS, BRACS-MS) with appropriate metrics. Our experiments show that continuous sampling substantially improves over discrete sampling at intermediate magnifications, with gains of up to 4 percentage points in balanced classification accuracy, and that optimized distributions can further improve performance. Finally, we evaluate current histopathology foundation models, finding that magnification is a primary driver of performance variation across models. Our work paves the way towards future pathology foundation models that perform reliably across magnifications.

cs.CV↗

arXiv2025

Towards Robust Foundation Models for Digital Pathology

Biomedical Foundation Models (FMs) are rapidly transforming AI-enabled healthcare research and entering clinical validation. However, their susceptibility to learning non-biological technical features -- including variations in surgical/endoscopic techniques, laboratory procedures, and scanner hardware -- poses risks for clinical deployment. We present the first systematic investigation of pathology FM robustness to non-biological features. Our work (i) introduces measures to quantify FM robustness, (ii) demonstrates the consequences of limited robustness, and (iii) proposes a framework for FM robustification to mitigate these issues. Specifically, we developed PathoROB, a robustness benchmark with three novel metrics, including the robustness index, and four datasets covering 28 biological classes from 34 medical centers. Our experiments reveal robustness deficits across all 20 evaluated FMs, and substantial robustness differences between them. We found that non-robust FM representations can cause major diagnostic downstream errors and clinical blunders that prevent safe clinical adoption. Using more robust FMs and post-hoc robustification considerably reduced (but did not yet eliminate) the risk of such errors. This work establishes that robustness evaluation is essential for validating pathology FMs before clinical adoption and demonstrates that future FM development must integrate robustness as a core design principle. PathoROB provides a blueprint for assessing robustness across biomedical domains, guiding FM improvement efforts towards more robust, representative, and clinically deployable AI systems that prioritize biological information over technical artifacts.

eess.IV↗

arXiv2025

Atlas: A Novel Pathology Foundation Model by Mayo Clinic, Charit\'e, and Aignostics

Recent advances in digital pathology have demonstrated the effectiveness of foundation models across diverse applications. In this report, we present Atlas, a novel vision foundation model based on the RudolfV approach. Our model was trained on a dataset comprising 1.2 million histopathology whole slide images, collected from two medical institutions: Mayo Clinic and Charit\'e - Universt\"atsmedizin Berlin. Comprehensive evaluations show that Atlas achieves state-of-the-art performance across twenty-one public benchmark datasets, even though it is neither the largest model by parameter count nor by training dataset size.

cs.CV↗

arXiv2024

xCG: Explainable Cell Graphs for Survival Prediction in Non-Small Cell Lung Cancer

Understanding how deep learning models predict oncology patient risk can provide critical insights into disease progression, support clinical decision-making, and pave the way for trustworthy and data-driven precision medicine. Building on recent advances in the spatial modeling of the tumor microenvironment using graph neural networks, we present an explainable cell graph (xCG) approach for survival prediction. We validate our model on a public cohort of imaging mass cytometry (IMC) data for 416 cases of lung adenocarcinoma. We explain survival predictions in terms of known phenotypes on the cell level by computing risk attributions over cell graphs, for which we propose an efficient grid-based layer-wise relevance propagation (LRP) method. Our ablation studies highlight the importance of incorporating the cancer stage and model ensembling to improve the quality of risk estimates. Our xCG method, together with the IMC data, is made publicly available to support further research.

cs.CV↗

arXiv2024

The Clever Hans Effect in Unsupervised Learning

Unsupervised learning has become an essential building block of AI systems. The representations it produces, e.g. in foundation models, are critical to a wide variety of downstream applications. It is therefore important to carefully examine unsupervised models to ensure not only that they produce accurate predictions, but also that these predictions are not "right for the wrong reasons", the so-called Clever Hans (CH) effect. Using specially developed Explainable AI techniques, we show for the first time that CH effects are widespread in unsupervised learning. Our empirical findings are enriched by theoretical insights, which interestingly point to inductive biases in the unsupervised learning machine as a primary source of CH effects. Overall, our work sheds light on unexplored risks associated with practical applications of unsupervised learning and suggests ways to make unsupervised learning more robust.

cs.LG↗

arXiv2024

AI-based Anomaly Detection for Clinical-Grade Histopathological Diagnostics

While previous studies have demonstrated the potential of AI to diagnose diseases in imaging data, clinical implementation is still lagging behind. This is partly because AI models require training with large numbers of examples only available for common diseases. In clinical reality, however, only few diseases are common, whereas the majority of diseases are less frequent (long-tail distribution). Current AI models overlook or misclassify these diseases. We propose a deep anomaly detection approach that only requires training data from common diseases to detect also all less frequent diseases. We collected two large real-world datasets of gastrointestinal biopsies, which are prototypical of the problem. Herein, the ten most common findings account for approximately 90% of cases, whereas the remaining 10% contained 56 disease entities, including many cancers. 17 million histological images from 5,423 cases were used for training and evaluation. Without any specific training for the diseases, our best-performing model reliably detected a broad spectrum of infrequent ("anomalous") pathologies with 95.0% (stomach) and 91.0% (colon) AUROC and generalized across scanners and hospitals. By design, the proposed anomaly detection can be expected to detect any pathological alteration in the diagnostic tail of gastrointestinal biopsies, including rare primary or metastatic cancers. This study establishes the first effective clinical application of AI-based anomaly detection in histopathology that can flag anomalous cases, facilitate case prioritization, reduce missed diagnoses and enhance the general safety of AI models, thereby driving AI adoption and automation in routine diagnostics and beyond.

cs.AI↗

arXiv2024

RudolfV: A Foundation Model by Pathologists for Pathologists

Artificial intelligence has started to transform histopathology impacting clinical diagnostics and biomedical research. However, while many computational pathology approaches have been proposed, most current AI models are limited with respect to generalization, application variety, and handling rare diseases. Recent efforts introduced self-supervised foundation models to address these challenges, yet existing approaches do not leverage pathologist knowledge by design. In this study, we present a novel approach to designing foundation models for computational pathology, incorporating pathologist expertise, semi-automated data curation, and a diverse dataset from over 15 laboratories, including 58 tissue types, and encompassing 129 different histochemical and immunohistochemical staining modalities. We demonstrate that our model "RudolfV" surpasses existing state-of-the-art foundation models across different benchmarks focused on tumor microenvironment profiling, biomarker evaluation, and reference case search while exhibiting favorable robustness properties. Our study shows how domain-specific knowledge can increase the efficiency and performance of pathology foundation models and enable novel application areas.

eess.IV↗

arXiv2023

DiffInfinite: Large Mask-Image Synthesis via Parallel Random Patch Diffusion in Histopathology

We present DiffInfinite, a hierarchical diffusion model that generates arbitrarily large histological images while preserving long-range correlation structural information. Our approach first generates synthetic segmentation masks, subsequently used as conditions for the high-fidelity generative diffusion process. The proposed sampling method can be scaled up to any desired image size while only requiring small patches for fast training. Moreover, it can be parallelized more efficiently than previous large-content generation methods while avoiding tiling artifacts. The training leverages classifier-free guidance to augment a small, sparsely annotated dataset with unlabelled data. Our method alleviates unique challenges in histopathological imaging practice: large-scale information, costly manual annotation, and protective data handling. The biological plausibility of DiffInfinite data is evaluated in a survey by ten experienced pathologists as well as a downstream classification and segmentation task. Samples from the model score strongly on anti-copying metrics which is relevant for the protection of patient data.

eess.IV↗

arXiv2023

Leveraging weak complementary labels to improve semantic segmentation of hepatocellular carcinoma and cholangiocarcinoma in H&E-stained slides

In this paper, we present a deep learning segmentation approach to classify and quantify the two most prevalent primary liver cancers - hepatocellular carcinoma and intrahepatic cholangiocarcinoma - from hematoxylin and eosin (H&E) stained whole slide images. While semantic segmentation of medical images typically requires costly pixel-level annotations by domain experts, there often exists additional information which is routinely obtained in clinical diagnostics but rarely utilized for model training. We propose to leverage such weak information from patient diagnoses by deriving complementary labels that indicate to which class a sample cannot belong to. To integrate these labels, we formulate a complementary loss for segmentation. Motivated by the medical application, we demonstrate for general segmentation tasks that including additional patches with solely weak complementary labels during model training can significantly improve the predictive performance and robustness of a model. On the task of diagnostic differentiation between hepatocellular carcinoma and intrahepatic cholangiocarcinoma, we achieve a balanced accuracy of 0.91 (CI 95%: 0.86 - 0.95) at case level for 165 hold-out patients. Furthermore, we also show that leveraging complementary labels improves the robustness of segmentation and increases performance at case level.

cs.CV↗

arXiv2022

Exposing Outlier Exposure: What Can Be Learned From Few, One, and Zero Outlier Images

Due to the intractability of characterizing everything that looks unlike the normal data, anomaly detection (AD) is traditionally treated as an unsupervised problem utilizing only normal samples. However, it has recently been found that unsupervised image AD can be drastically improved through the utilization of huge corpora of random images to represent anomalousness; a technique which is known as Outlier Exposure. In this paper we show that specialized AD learning methods seem unnecessary for state-of-the-art performance, and furthermore one can achieve strong performance with just a small collection of Outlier Exposure data, contradicting common assumptions in the field of AD. We find that standard classifiers and semi-supervised one-class methods trained to discern between normal samples and relatively few random natural images are able to outperform the current state of the art on an established AD benchmark with ImageNet. Further experiments reveal that even one well-chosen outlier sample is sufficient to achieve decent performance on this benchmark (79.3% AUC). We investigate this phenomenon and find that one-class methods are more robust to the choice of training outliers, indicating that there are scenarios where these are still more useful than standard classifiers. Additionally, we include experiments that delineate the scenarios where our results hold. Lastly, no training samples are necessary when one uses the representations learned by CLIP, a recent foundation model, which achieves state-of-the-art AD results on CIFAR-10 and ImageNet in a zero-shot setting.

cs.CV↗

arXiv2020

Deep Anomaly Detection by Residual Adaptation

Deep anomaly detection is a difficult task since, in high dimensions, it is hard to completely characterize a notion of "differentness" when given only examples of normality. In this paper we propose a novel approach to deep anomaly detection based on augmenting large pretrained networks with residual corrections that adjusts them to the task of anomaly detection. Our method gives rise to a highly parameter-efficient learning mechanism, enhances disentanglement of representations in the pretrained model, and outperforms all existing anomaly detection methods including other baselines utilizing pretrained networks. On the CIFAR-10 one-versus-rest benchmark, for example, our technique raises the state of the art from 96.1 to 99.0 mean AUC.

cs.LG↗

arXiv2020

Geometric Disentanglement by Random Convex Polytopes

We propose a new geometric method for measuring the quality of representations obtained from deep learning. Our approach, called Random Polytope Descriptor, provides an efficient description of data points based on the construction of random convex polytopes. We demonstrate the use of our technique by qualitatively comparing the behavior of classic and regularized autoencoders. This reveals that applying regularization to autoencoder networks may decrease the out-of-distribution detection performance in latent space. While our technique is similar in spirit to $k$-means clustering, we achieve significantly better false positive/negative balance in clustering tasks on autoencoded datasets.

cs.LG↗

arXiv2020

A Unifying Review of Deep and Shallow Anomaly Detection

Deep learning approaches to anomaly detection have recently improved the state of the art in detection performance on complex datasets such as large collections of images or text. These results have sparked a renewed interest in the anomaly detection problem and led to the introduction of a great variety of new methods. With the emergence of numerous such methods, including approaches based on generative models, one-class classification, and reconstruction, there is a growing need to bring methods of this field into a systematic and unified perspective. In this review we aim to identify the common underlying principles as well as the assumptions that are often made implicitly by various methods. In particular, we draw connections between classic 'shallow' and novel deep approaches and show how this relation might cross-fertilize or extend both directions. We further provide an empirical assessment of major existing methods that is enriched by the use of recent explainability techniques, and present specific worked-through examples together with practical advice. Finally, we outline critical open challenges and identify specific paths for future research in anomaly detection.

cs.LG↗

arXiv2020

Explainable Deep One-Class Classification

Deep one-class classification variants for anomaly detection learn a mapping that concentrates nominal samples in feature space causing anomalies to be mapped away. Because this transformation is highly non-linear, finding interpretations poses a significant challenge. In this paper we present an explainable deep one-class classification method, Fully Convolutional Data Description (FCDD), where the mapped samples are themselves also an explanation heatmap. FCDD yields competitive detection performance and provides reasonable explanations on common anomaly detection benchmarks with CIFAR-10 and ImageNet. On MVTec-AD, a recent manufacturing dataset offering ground-truth anomaly maps, FCDD sets a new state of the art in the unsupervised setting. Our method can incorporate ground-truth anomaly maps during training and using even a few of these (~5) improves performance significantly. Finally, using FCDD's explanations we demonstrate the vulnerability of deep one-class classification models to spurious image features such as image watermarks.

cs.CV↗