arXiv subjects

Mireia Crispin-Ortuzar

Publications and source records attributed to Mireia Crispin-Ortuzar.

18 recordsLinked to original sources

arXiv2026

PlanPath: Exploration-Guided Orchestration for Patient-Level Pathology Reasoning

A patient's pathology case spans tens of slides from distinct specimens and anatomical sites, each carrying non-redundant, site-specific evidence. Forming a patient-level conclusion therefore requires locating the slides relevant to a given question and integrating complementary findings across them. However, existing pathology agents analyze one slide at a time and describe morphology rather than measure it, leaving evidence acquisition across a patient's specimens and patient-level quantification underexplored. To address this gap, we propose PlanPath, an agentic framework for patient-level pathology visual question answering (VQA). PlanPath turns the question into an exploration plan that specifies the evidence required, routes to the slides likely to carry it, and drives coarse-to-fine acquisition from tissue architecture down to individual cells. Tissue- and cell-level tools supply the counts, proportions, and extents, which PlanPath aggregates across slides into a traceable answer. To enable evaluation, we build two patient-level VQA datasets for renal and gastric cancer, averaging 15 WSIs per patient, with pathologist-verified question-answer pairs derived from diagnostic reports. Experimental results show that PlanPath outperforms the strongest baseline by 9.4% and 12.1% in overall accuracy on the two datasets and further improves existing slide-level agents when plugged into our framework. The dataset and code are available at: https://github.com/JSGe-AI/PlanPath_1.

cs.CV↗

arXiv2026

Modeling Whole-Slide Images as Dynamic Tumor Microenvironment Fields

Due to the gigapixel-scale nature of whole-slide images (WSIs), weakly supervised WSI analysis is commonly formulated as a multiple instance learning (MIL) problem, where patch-level features are aggregated into slide-level representations. However, diagnostic and prognostic evidence often arises from spatially coherent tumor microenvironment regions and their interactions, rather than isolated patches alone. Existing patch-level or static region-based methods usually overlook how tissue regions should be adaptively formed and subsequently evolved through microenvironment interactions across heterogeneous boundaries. In this paper, we propose Concept-Guided Tumor Microenvironment Evolution (TMEvolve), a reaction-diffusion-inspired framework that models WSIs as latent tumor microenvironment fields over discrete patch graphs. TMEvolve instantiates this view as a learnable graph-discretized evolution process over patch neighborhoods. It first forms adaptive soft tissue regions as coherent microenvironment units, then performs pseudo-time evolution through two complementary local dynamics: intra-region diffusion, which stabilizes latent states within coherent tissue compartments, and concept-guided boundary flux, which propagates visual feature signals and language-derived concept signals across heterogeneous region interfaces. The evolved microenvironment regions are finally aggregated for slide-level prediction. We evaluate TMEvolve on six datasets across three weakly supervised WSI tasks: survival prediction, gene expression prediction, and histological subtype classification. TMEvolve consistently improves over representative MIL methods, pathology foundation models, and concept-guided baselines. Ablation studies and visualizations further support the effectiveness and interpretability of TMEvolve, highlighting the value of dynamic region modeling and boundary interaction.

cs.CV↗

arXiv2026

Can Protein-Derived Knowledge Improve Pathology Foundation Models?

Molecularly guided pathology foundation models (PFMs) exploit transcriptomic or proteomic information to enrich whole-slide image (WSI) representations, yet effectively leveraging large standalone molecular corpora remains challenging. First, existing molecular foundation models encode protein sequences or single-cell states, not the patient-level bulk expression profiles paired with WSIs. Second, because cross-modal supervision is restricted to paired WSI-omics samples, knowledge from standalone molecular corpora reaches the pathology encoder only indirectly, creating a paired-support bottleneck. To address these challenges, we propose a three-stage framework that decouples proteomic knowledge acquisition from cross-modal transfer, yielding ProSlide, a slide-level hierarchical pathology foundation model. First, to close the modality gap, we pretrain a Proteomic Foundation Encoder (PFE) on 12,695 sample-level bulk protein profiles using virtual profile generation and expression-space multi-view pretraining. Second, we pretrain ProSlide, a patch-region-slide encoder, to predict protein expression from paired WSI-protein samples. Third, to relax the paired-support bottleneck, we introduce Prot2Path, a cross-modal relational distillation objective. For each paired sample, it aligns the similarity distributions of the WSI and its protein profile over a shared, frozen bank of PFE-encoded paired and standalone profiles. We evaluate ProSlide on 12 downstream tasks across breast, lung, and renal cancers. Despite being pretrained with only 2,229 WSIs and 12,695 sample-level protein profiles, ProSlide achieves the highest mean accuracy and AUC within each cancer group.

cs.CV↗

arXiv2026

Data-driven registration and modeling of brain deformation for image-guided neurosurgery

Accurate compensation of brain deformation is critical for reliable image-guided neurosurgery. Surgical manipulation and tumor resection induce tissue motion, causing preoperative planning images to become misaligned with the intraoperative anatomy. In this review, we examine data-driven methods developed between 2020 and 2025 for brain deformation registration and modeling, with a particular focus on learning-based approaches. A comprehensive literature search was conducted in PubMed, IEEE Xplore, Scopus, and Web of Science using predefined inclusion and exclusion criteria for computational methods addressing brain deformation in neurosurgical imaging, resulting in 46 eligible studies. We provide a unified analysis of methodological strategies, including deep learning-based image registration, direct deformation field regression, synthesis-driven multimodal alignment, resection-aware architectures for handling missing correspondences, and hybrid models integrating biomechanical priors. We also examine dataset utilization, evaluation metrics, validation protocols, and the assessment of uncertainty and generalization across studies. While learning-based methods demonstrate promising accuracy and computational efficiency, current approaches remain limited by out-of-distribution robustness, standardized benchmarking, interpretability, and readiness for clinical deployment. Our review highlights these gaps and outlines future directions toward more robust, generalizable, and clinically translatable solutions for neurosurgical guidance. By organizing recent advances and critically assessing evaluation practices, this work provides a comprehensive reference for researchers and clinicians working on data-driven registration and modeling of brain deformation.

eess.IV↗

arXiv2026

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

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.

cs.CV↗

arXiv2026

AGE-MIL: Anchor-Guided Evidence Learning for Patient-Level Prediction

Existing computational pathology methods predominantly operate within whole-slide image (WSI)-level multiple instance learning (MIL) paradigms, while patient-level modeling remains underexplored. In routine pathological practice, however, pathologists derive diagnostic and prognostic conclusions by integrating evidence across multiple WSIs rather than relying on any single slide. This discrepancy creates a fundamental misalignment when patient-level supervision is directly imposed on conventional MIL frameworks, often leading to unstable optimization and degraded predictive reliability. To address this issue, we propose Anchor-Guided Evidence MIL (AGE-MIL), a weakly supervised framework for patient-level prediction. AGE-MIL constructs a patient-level anchor from slide representations to capture global pathological context and guide the retrieval and integration of diagnostically relevant local patches, enabling robust patient-level modeling. Patient-level risk is further modeled as an evidence accumulation process, promoting stable optimization under weak supervision. AGE-MIL is evaluated on six clinically relevant patient-level prediction tasks from two independent cohorts. Experimental results show that the proposed framework consistently outperforms eight state-of-the-art MIL methods. Code is available at https://github.com/wodeniua/AGE-MIL.

cs.CV↗

arXiv2026

Vision Transformers for Preoperative CT-Based Prediction of Histopathologic Chemotherapy Response Score in High-Grade Serous Ovarian Carcinoma

Purpose. High-grade serous ovarian carcinoma (HGSOC) is characterized by pronounced biological and spatial heterogeneity and is frequently diagnosed at an advanced stage. Neoadjuvant chemotherapy (NACT) followed by delayed primary surgery is commonly employed in patients unsuitable for primary cytoreduction. The Chemotherapy Response Score (CRS) is a validated histopathological biomarker of response to NACT, but it is only available postoperatively. In this study, we investigate whether pre-treatment computed tomography (CT) imaging and clinical data can be used to predict CRS as an investigational decision-support adjunct to inform multidisciplinary team (MDT) discussions regarding expected treatment response. Methods. We proposed a 2.5D multimodal deep learning framework that processes lesion-dense omental slices using a pre-trained Vision Transformer encoder and integrates the resulting visual representations with clinical variables through an intermediate fusion module to predict CRS. Results. Our multimodal model, integrating imaging and clinical data, achieved a ROC-AUC of 0.95 alongside 95% accuracy and 80% precision on the internal test cohort (IEO, n=41 patients). On the external test set (OV04, n=70 patients), it achieved a ROC-AUC of 0.68, alongside 67% accuracy and 75% precision. Conclusion. These preliminary results demonstrate the feasibility of transformer-based deep learning for preoperative prediction of CRS in HGSOC using routine clinical data and CT imaging. As an investigational, pre-treatment decision-support tool, this approach may assist MDT discussions by providing early, non-invasive estimates of treatment response.

cs.CV↗

arXiv2026

CARE: A Molecular-Guided Foundation Model with Adaptive Region Modeling for Whole Slide Image Analysis

Foundation models have recently achieved impressive success in computational pathology, demonstrating strong generalization across diverse histopathology tasks. However, existing models overlook the heterogeneous and non-uniform organization of pathological regions of interest (ROIs) because they rely on natural image backbones not tailored for tissue morphology. Consequently, they often fail to capture the coherent tissue architecture beyond isolated patches, limiting interpretability and clinical relevance. To address these challenges, we present Cross-modal Adaptive Region Encoder (CARE), a foundation model for pathology that automatically partitions WSIs into several morphologically relevant regions. Specifically, CARE employs a two-stage pretraining strategy: (1) a self-supervised unimodal pretraining stage that learns morphological representations from 34,277 whole-slide images (WSIs) without segmentation annotations, and (2) a cross-modal alignment stage that leverages RNA and protein profiles to refine the construction and representation of adaptive regions. This molecular guidance enables CARE to identify biologically relevant patterns and generate irregular yet coherent tissue regions, selecting the most representative area as ROI. CARE supports a broad range of pathology-related tasks, using either the ROI feature or the slide-level feature obtained by aggregating adaptive regions. Based on only one-tenth of the pretraining data typically used by mainstream foundation models, CARE achieves superior average performance across 33 downstream benchmarks, including morphological classification, molecular prediction, and survival analysis, and outperforms other foundation model baselines overall.

cs.CV↗

arXiv2026

Developing Predictive and Robust Radiomics Models for Chemotherapy Response in High-Grade Serous Ovarian Carcinoma

Objectives: High-grade serous ovarian carcinoma (HGSOC) is typically diagnosed at an advanced stage with extensive peritoneal metastases, making treatment challenging. Neoadjuvant chemotherapy (NACT) is often used to reduce tumor burden before surgery, but about 40% of patients show limited response. Radiomics, combined with machine learning (ML), offers a promising non-invasive method for predicting NACT response by analyzing computed tomography (CT) imaging data. This study aimed to improve response prediction in HGSOC patients undergoing NACT by integration different feature selection methods. Materials and methods: A framework for selecting robust radiomics features was introduced by employing an automated randomisation algorithm to mimic inter-observer variability, ensuring a balance between feature robustness and prediction accuracy. Four response metrics were used: chemotherapy response score (CRS), RECIST, volume reduction (VolR), and diameter reduction (DiaR). Lesions in different anatomical sites were studied. Pre- and post-NACT CT scans were used for feature extraction and model training on one cohort, and an independent cohort was used for external testing. Results: The best prediction performance was achieved using all lesions combined for VolR prediction, with an AUC of 0.83. Omental lesions provided the best results for CRS prediction (AUC 0.77), while pelvic lesions performed best for DiaR (AUC 0.76). Conclusion: The integration of robustness into the feature selection processes ensures the development of reliable models and thus facilitates the implementation of the radiomics models in clinical applications for HGSOC patients. Future work should explore further applications of radiomics in ovarian cancer, particularly in real-time clinical settings.

cs.CV↗

arXiv2025

CoxKAN: Kolmogorov-Arnold Networks for Interpretable, High-Performance Survival Analysis

Motivation: Survival analysis is a branch of statistics that is crucial in medicine for modeling the time to critical events such as death or relapse, in order to improve treatment strategies and patient outcomes. Selecting survival models often involves a trade-off between performance and interpretability; deep learning models offer high performance but lack the transparency of more traditional approaches. This poses a significant issue in medicine, where practitioners are reluctant to use black-box models for critical patient decisions. Results: We introduce CoxKAN, a Cox proportional hazards Kolmogorov-Arnold Network for interpretable, high-performance survival analysis. Kolmogorov-Arnold Networks (KANs) were recently proposed as an interpretable and accurate alternative to multi-layer perceptrons. We evaluated CoxKAN on four synthetic and nine real datasets, including five cohorts with clinical data and four with genomics biomarkers. In synthetic experiments, CoxKAN accurately recovered interpretable hazard function formulae and excelled in automatic feature selection. Evaluations on real datasets showed that CoxKAN consistently outperformed the traditional Cox proportional hazards model (by up to 4% in C-index) and matched or surpassed the performance of deep learning-based models. Importantly, CoxKAN revealed complex interactions between predictor variables and uncovered symbolic formulae, which are key capabilities that other survival analysis methods lack, to provide clear insights into the impact of key biomarkers on patient risk. Availability and implementation: CoxKAN is available at GitHub and Zenodo

cs.LG↗

arXiv2025

R$^{2}$Seg: Training-Free OOD Medical Tumor Segmentation via Anatomical Reasoning and Statistical Rejection

Foundation models for medical image segmentation struggle under out-of-distribution (OOD) shifts, often producing fragmented false positives on OOD tumors. We introduce R$^{2}$Seg, a training-free framework for robust OOD tumor segmentation that operates via a two-stage Reason-and-Reject process. First, the Reason step employs an LLM-guided anatomical reasoning planner to localize organ anchors and generate multi-scale ROIs. Second, the Reject step applies two-sample statistical testing to candidates generated by a frozen foundation model (BiomedParse) within these ROIs. This statistical rejection filter retains only candidates significantly different from normal tissue, effectively suppressing false positives. Our framework requires no parameter updates, making it compatible with zero-update test-time augmentation and avoiding catastrophic forgetting. On multi-center and multi-modal tumor segmentation benchmarks, R$^{2}$Seg substantially improves Dice, specificity, and sensitivity over strong baselines and the original foundation models. Code are available at https://github.com/Eurekashen/R2Seg.

cs.CV↗

arXiv2025

Evaluating Foundation Models with Pathological Concept Learning for Kidney Cancer

To evaluate the translational capabilities of foundation models, we develop a pathological concept learning approach focused on kidney cancer. By leveraging TNM staging guidelines and pathology reports, we build comprehensive pathological concepts for kidney cancer. Then, we extract deep features from whole slide images using foundation models, construct pathological graphs to capture spatial correlations, and trained graph neural networks to identify these concepts. Finally, we demonstrate the effectiveness of this approach in kidney cancer survival analysis, highlighting its explainability and fairness in identifying low- and high-risk patients. The source code has been released by https://github.com/shangqigao/RadioPath.

cs.AI↗

arXiv2025

Integrating Pathology and CT Imaging for Personalized Recurrence Risk Prediction in Renal Cancer

Recurrence risk estimation in clear cell renal cell carcinoma (ccRCC) is essential for guiding postoperative surveillance and treatment. The Leibovich score remains widely used for stratifying distant recurrence risk but offers limited patient-level resolution and excludes imaging information. This study evaluates multimodal recurrence prediction by integrating preoperative computed tomography (CT) and postoperative histopathology whole-slide images (WSIs). A modular deep learning framework with pretrained encoders and Cox-based survival modeling was tested across unimodal, late fusion, and intermediate fusion setups. In a real-world ccRCC cohort, WSI-based models consistently outperformed CT-only models, underscoring the prognostic strength of pathology. Intermediate fusion further improved performance, with the best model (TITAN-CONCH with ResNet-18) approaching the adjusted Leibovich score. Random tie-breaking narrowed the gap between the clinical baseline and learned models, suggesting discretization may overstate individualized performance. Using simple embedding concatenation, radiology added value primarily through fusion. These findings demonstrate the feasibility of foundation model-based multimodal integration for personalized ccRCC risk prediction. Future work should explore more expressive fusion strategies, larger multimodal datasets, and general-purpose CT encoders to better match pathology modeling capacity.

cs.CV↗

arXiv2025

PH2ST:ST-Prompt Guided Histological Hypergraph Learning for Spatial Gene Expression Prediction

Spatial Transcriptomics (ST) reveals the spatial distribution of gene expression in tissues, offering critical insights into biological processes and disease mechanisms. However, the high cost, limited coverage, and technical complexity of current ST technologies restrict their widespread use in clinical and research settings, making obtaining high-resolution transcriptomic profiles across large tissue areas challenging. Predicting ST from H\&E-stained histology images has emerged as a promising alternative to address these limitations but remains challenging due to the heterogeneous relationship between histomorphology and gene expression, which is affected by substantial variability across patients and tissue sections. In response, we propose PH2ST, a prompt-guided hypergraph learning framework, which leverages limited ST signals to guide multi-scale histological representation learning for accurate and robust spatial gene expression prediction. Extensive evaluations on two public ST datasets and multiple prompt sampling strategies simulating real-world scenarios demonstrate that PH2ST not only outperforms existing state-of-the-art methods, but also shows strong potential for practical applications such as imputing missing spots, ST super-resolution, and local-to-global prediction, highlighting its value for scalable and cost-effective spatial gene expression mapping in biomedical contexts.

cs.CV↗

arXiv2024

CTARR: A fast and robust method for identifying anatomical regions on CT images via atlas registration

Medical image analysis tasks often focus on regions or structures located in a particular location within the patient's body. Often large parts of the image may not be of interest for the image analysis task. When using deep-learning based approaches, this causes an unnecessary increases the computational burden during inference and raises the chance of errors. In this paper, we introduce CTARR, a novel generic method for CT Anatomical Region Recognition. The method serves as a pre-processing step for any deep learning-based CT image analysis pipeline by automatically identifying the pre-defined anatomical region that is relevant for the follow-up task and removing the rest. It can be used in (i) image segmentation to prevent false positives in anatomically implausible regions and speeding up the inference, (ii) image classification to produce image crops that are consistent in their anatomical context, and (iii) image registration by serving as a fast pre-registration step. Our proposed method is based on atlas registration and provides a fast and robust way to crop any anatomical region encoded as one or multiple bounding box(es) from any unlabeled CT scan of the brain, chest, abdomen and/or pelvis. We demonstrate the utility and robustness of the proposed method in the context of medical image segmentation by evaluating it on six datasets of public segmentation challenges. The foreground voxels in the regions of interest are preserved in the vast majority of cases and tasks (97.45-100%) while taking only fractions of a seconds to compute (0.1-0.21s) on a deep learning workstation and greatly reducing the segmentation runtime (2.0-12.7x). Our code is available at https://github.com/ThomasBudd/ctarr.

cs.CV↗

arXiv2023

Automated Small Kidney Cancer Detection in Non-Contrast Computed Tomography

This study introduces an automated pipeline for renal cancer (RC) detection in non-contrast computed tomography (NCCT). In the development of our pipeline, we test three detections models: a shape model, a 2D-, and a 3D axial-sample model. Training (n=1348) and testing (n=64) data were gathered from open sources (KiTS23, Abdomen1k, CT-ORG) and Cambridge University Hospital (CUH). Results from cross-validation and testing revealed that the 2D axial sample model had the highest small ($\leq$40mm diameter) RC detection area under the curve (AUC) of 0.804. Our pipeline achieves 61.9\% sensitivity and 92.7\% specificity for small kidney cancers on unseen test data. Our results are much more accurate than previous attempts to automatically detect small renal cancers in NCCT, the most likely imaging modality for RC screening. This pipeline offers a promising advance that may enable screening for kidney cancers.

eess.IV↗

arXiv2022

Calibrating Ensembles for Scalable Uncertainty Quantification in Deep Learning-based Medical Segmentation

Uncertainty quantification in automated image analysis is highly desired in many applications. Typically, machine learning models in classification or segmentation are only developed to provide binary answers; however, quantifying the uncertainty of the models can play a critical role for example in active learning or machine human interaction. Uncertainty quantification is especially difficult when using deep learning-based models, which are the state-of-the-art in many imaging applications. The current uncertainty quantification approaches do not scale well in high-dimensional real-world problems. Scalable solutions often rely on classical techniques, such as dropout, during inference or training ensembles of identical models with different random seeds to obtain a posterior distribution. In this paper, we show that these approaches fail to approximate the classification probability. On the contrary, we propose a scalable and intuitive framework to calibrate ensembles of deep learning models to produce uncertainty quantification measurements that approximate the classification probability. On unseen test data, we demonstrate improved calibration, sensitivity (in two out of three cases) and precision when being compared with the standard approaches. We further motivate the usage of our method in active learning, creating pseudo-labels to learn from unlabeled images and human-machine collaboration.

cs.LG↗

arXiv2014

Toward Early-Warning Detection of Gravitational Waves from Compact Binary Coalescence

Rapid detection of compact binary coalescence (CBC) with a network of advanced gravitational-wave detectors will offer a unique opportunity for multi-messenger astronomy. Prompt detection alerts for the astronomical community might make it possible to observe the onset of electromagnetic emission from (CBC). We demonstrate a computationally practical filtering strategy that could produce early-warning triggers before gravitational radiation from the final merger has arrived at the detectors.

astro-ph.IM↗