Minimal High-Resolution Patches Are Sufficient for Whole Slide Image Representation via Cascaded Dual-Scale Reconstruction

Abstract: Whole-slide image (WSI) analysis remains challenging due to the gigapixel scale and sparsely distributed diagnostic regions. Multiple Instance Learning (MIL) mitigates this by modeling the WSI as bags of patches for slide-level prediction. However, most MIL approaches emphasize aggregator design while overlooking the impact of the feature extractor of the feature extraction stage, which is often pretrained on natural images. This leads to domain gap and suboptimal representations. Self-supervised learning (SSL) has shown promise in bridging domain gap via pretext tasks, but it still primarily builds upon generic backbones, thus requiring WSIs to be split into small patches. This inevitably splits histological structures and generates both redundant and interdependent patches, which in turn degrades aggregator performance and drastically increases training costs. To address this challenge, we propose a Cascaded Dual-Scale Reconstruction (CDSR) framework, demonstrating that only an average of 9 high-resolution patches per WSI are sufficient for robust slide-level representation. CDSR employs a two-stage selective sampling strategy that identifies the most informative representative regions from both model-based and semantic perspectives. These patches are then fed into a Local-to-Global Network, which reconstructs spatially coherent high-resolution WSI representations by integrating fine-grained local detail with global contextual information. Unlike existing dense-sampling or SSL pipelines, CDSR is optimized for efficiency and morphological fidelity. Experiments on Camelyon16, TCGA-NSCLC, and TCGA-RCC demonstrate that CDSR achieves improvements of 6.3% in accuracy and 5.5% in area under ROC curve on downstream classification tasks with only 7,070 (4.5% of total) high-resolution patches per dataset on average, outperforming state-of-the-art methods trained on over 10,000,000 patches.