Digital pathology

Digital Pathology

Overview

This skill teaches the agent to generate correct, runnable code for whole-slide image (WSI) pipelines. It covers TIAToolbox CLI and Python API, the H-optimus-0 foundation model, the standard tissue→tiles→features→aggregate→predict pattern, the CAMELYON datasets, and SageMaker deployment patterns for regulated workloads.

Default to TIAToolbox primitives (WSIReader, PatchPredictor, DeepFeatureExtractor) rather than reimplementing slide I/O. Default to H-optimus-0 at 0.5 mpp / 224×224 unless the task specifies otherwise.

Usage

Invoke this skill when the user asks to:

• Inspect, tile, or stain-normalize a WSI (SVS, NDPI, MRXS, pyramidal TIFF).
• Extract features with a pathology foundation model.
• Build a slide-level classifier on CAMELYON or similar cohorts.
• Deploy a WSI model to AWS SageMaker.

Ask for clarification only if the resolution, model, or output artifact is ambiguous. Otherwise apply the defaults in the Resolution Rules section.

Response Format

• Lead with the command or code the user needs — explain after
• Structure as: confirm inputs → working code → key parameters explained → gotchas
• One complete working example per task; do not show every alternative
• Keep code comments minimal and functional (what, not why-it-exists)
• Target: 50-100 lines of code with brief surrounding explanation

Core Concepts

• Pyramidal WSI: multi-resolution image (levels). baseline = level 0 (native, finest). Addressing uses resolution + units ∈ {mpp, power, level, baseline}.
• mpp: microns per pixel. 0.5 mpp ≈ 20×, 0.25 mpp ≈ 40×. Downsample = baseline_mpp / target_mpp.
• Tissue mask: binary foreground mask computed at low resolution (e.g., Otsu at 1.25× or 4 mpp) to skip background tiles.
• Patch / tile: fixed-size crop (e.g., 224×224) read at a target mpp, used as model input.
• Foundation model embedding: per-tile feature vector from a pretrained ViT (H-optimus-0 → 1536-d).
• Aggregation: slide-level prediction from tile features (ABMIL, CLAM, TransMIL, SlideGraph).

Quick Reference — Standard Pipeline

Copy-adapt this end-to-end pattern for any WSI classification task:

import torch
from tiatoolbox.wsicore.wsireader import WSIReader
from tiatoolbox.models.architecture.vanilla import TimmBackbone
from tiatoolbox.models.engine.semantic_segmentor import IOSegmentorConfig
from tiatoolbox.models.engine.patch_predictor import IOPatchPredictorConfig
from tiatoolbox.models import DeepFeatureExtractor

SLIDE = "slide.svs"
OUT = "./out"
DEVICE = "cuda" if torch.cuda.is_available() else "cpu"

# 1. Inspect
reader = WSIReader.open(SLIDE)
info = reader.info.as_dict()
print(info["mpp"], info["level_dimensions"])

# 2. Tissue mask (Otsu at low res — do NOT pass as external mask)
mask_reader = reader.tissue_mask(method="otsu", resolution=4, units="mpp")

# 3. Tile + extract H-optimus-0 features @ 0.5 mpp, 224x224
ioconfig = IOPatchPredictorConfig(
    input_resolutions=[{"units": "mpp", "resolution": 0.5}],
    patch_input_shape=[224, 224],
    stride_shape=[224, 224],
)
extractor = DeepFeatureExtractor(
    model=TimmBackbone("H-optimus-0", pretrained=True),
    batch_size=16,
    num_loader_workers=4,
)
output = extractor.run(
    images=[SLIDE],
    masks=[mask_reader],
    patch_mode=False,
    ioconfig=ioconfig,
    save_dir=OUT,
    device=DEVICE,
)
# output[0] -> (positions.npy, features.npy)

Then aggregate (ABMIL / SlideGraph / mean-pool) on features.npy for a slide-level prediction.

TIAToolbox CLI

All CLI commands accept --img-input (file or dir), --output-path, --resolution, --units, --batch-size, --device cuda.

# Slide metadata
tiatoolbox slide-info --img-input slide.svs --mode show

# Tissue mask (binary PNG)
tiatoolbox tissue-mask --img-input slide.svs --output-path ./mask --method otsu \
  --resolution 1.25 --units power

# Tile classification with built-in ResNet18 on Kather100k
tiatoolbox patch-predictor --img-input slide.svs \
  --pretrained-model resnet18-kather100k \
  --output-path ./pred --batch-size 32 --device cuda \
  --resolution 0.5 --units mpp

# Stain normalization (Reinhard / Macenko / Vahadane)
tiatoolbox stain-norm --img-input tiles/ --method reinhard --output-path ./norm

Use --units baseline when inputs are pre-extracted PNG tiles to avoid an "unknown scale" warning.

TIAToolbox Python API

WSIReader

from tiatoolbox.wsicore.wsireader import WSIReader

reader = WSIReader.open("slide.svs")
reader.info.as_dict()                              # mpp, levels, vendor
reader.slide_dimensions(resolution=0.5, units="mpp")

tile = reader.read_rect(
    location=(10000, 10000),    # baseline coords
    size=(224, 224),
    resolution=0.5, units="mpp",
)
region = reader.read_bounds(
    bounds=(0, 0, 4096, 4096),
    resolution=2.0, units="mpp",
)
mask = reader.tissue_mask(method="otsu", resolution=4, units="mpp")

PatchPredictor

from tiatoolbox.models import PatchPredictor
from tiatoolbox.models.engine.patch_predictor import IOPatchPredictorConfig

ioconfig = IOPatchPredictorConfig(
    input_resolutions=[{"units": "mpp", "resolution": 0.5}],
    patch_input_shape=[224, 224],
    stride_shape=[224, 224],
)
predictor = PatchPredictor(pretrained_model="resnet18-kather100k", batch_size=32)
out = predictor.run(
    images=["slide.svs"], masks=[mask],
    patch_mode=False, ioconfig=ioconfig,
    save_dir="./pred", device="cuda",
)

DeepFeatureExtractor + TimmBackbone

from tiatoolbox.models import DeepFeatureExtractor
from tiatoolbox.models.architecture.vanilla import TimmBackbone

extractor = DeepFeatureExtractor(
    model=TimmBackbone("H-optimus-0", pretrained=True),
    batch_size=16, num_loader_workers=4,
)

SlideGraph construction

import numpy as np
from tiatoolbox.tools.graph import SlideGraphConstructor

positions = np.load("out/0.position.npy")   # (N, 4) x1,y1,x2,y2
features  = np.load("out/0.features.npy")   # (N, D)
graph = SlideGraphConstructor.build(
    positions=positions[:, :2], features=features,
)
# graph -> {"x": features, "edge_index": (2,E), "coords": (N,2)}

Stain normalization

from tiatoolbox.tools.stainnorm import get_normalizer

norm = get_normalizer("reinhard")   # or "macenko", "vahadane"
norm.fit(target_tile)               # RGB ndarray HxWx3
normed = norm.transform(source_tile)

H-optimus-0 Foundation Model

1.1B-parameter ViT-G/14, input 224×224 RGB at 0.5 mpp, output 1536-d embedding. License is gated — accept terms on Hugging Face and run huggingface-cli login.

Direct timm usage

import timm, torch
from torchvision import transforms

model = timm.create_model(
    "hf-hub:bioptimus/H-optimus-0",
    pretrained=True,
    init_values=1e-5,
    dynamic_img_size=False,
).eval().to("cuda")

preprocess = transforms.Compose([
    transforms.ToTensor(),
    transforms.Normalize(
        mean=(0.707223, 0.578729, 0.703617),
        std=(0.211883, 0.230117, 0.177517),
    ),
])

with torch.inference_mode(), torch.autocast("cuda", dtype=torch.float16):
    feats = model(preprocess(tile).unsqueeze(0).to("cuda"))   # (1, 1536)

Use batch_size=16 on a 24 GB GPU with fp16 autocast. Prefer TimmBackbone("H-optimus-0", pretrained=True) inside DeepFeatureExtractor — TIAToolbox applies the correct preprocessing automatically.

Resolution Rules

Model	mpp	Patch size
H-optimus-0 / UNI / Prov-GigaPath	0.5	224×224
HoVer-Net (PanNuke)	0.25	256×256
SlideGraph CNN features	0.25	512×512
Tissue mask (Otsu)	4 mpp or 1.25×	—

Downsample factor = baseline_mpp / target_mpp. For a 0.25-mpp slide targeting 0.5 mpp, downsample by 2.

CAMELYON Datasets

• Format: pyramidal .tif, OpenSlide-compatible, ~100 000 × 100 000 px at baseline.
• Annotations: ASAP XML, polygon coordinates in baseline (level-0) pixels.
• CAMELYON16: 270 training slides (normal/ + tumor/) + 130 test slides, labels in reference.csv. Task: slide-level tumor classification + tumor segmentation.
• CAMELYON17: 1000 slides across 100 patients (5 slides each). Patient-level pN-stage in stages.csv. Official 5-fold split is by patient — never split by slide.

import xml.etree.ElementTree as ET
tree = ET.parse("slide.xml")                 # ASAP format
for ann in tree.iter("Annotation"):
    pts = [(float(c.get("X")), float(c.get("Y")))
           for c in ann.iter("Coordinate")]   # baseline coords

SageMaker Deployment

WSIs are gigapixel — never send raw bytes through the invocation path. Pass an S3 URI in the request and let the container read via s3fs / boto3.

• Endpoint type: Async Inference (long-running, per-request) or Batch Transform (cohort scoring).
• Base container: extend 763104351884.dkr.ecr.<region>.amazonaws.com/pytorch-inference:2.x-gpu-py310.
• Apt packages: openslide-tools libpixman-1-dev libvips.
• Pip: tiatoolbox timm huggingface_hub s3fs.
• Instance: ml.g5.2xlarge minimum for H-optimus-0 fp16 (24 GB A10G). Use ml.g5.12xlarge for batches.
• Async config: invocations_timeout=3600, max_concurrent_invocations_per_instance=2.

from sagemaker.async_inference import AsyncInferenceConfig
async_config = AsyncInferenceConfig(
    output_path="s3://bucket/async-out/",
    max_concurrent_invocations_per_instance=2,
)
predictor = model.deploy(
    instance_type="ml.g5.2xlarge", initial_instance_count=1,
    async_inference_config=async_config,
)
predictor.predict_async(input_path="s3://bucket/slides/slide.svs")

Dockerfile sketch:

FROM 763104351884.dkr.ecr.us-east-1.amazonaws.com/pytorch-inference:2.3.0-gpu-py310
RUN apt-get update && apt-get install -y openslide-tools libpixman-1-dev libvips \
 && rm -rf /var/lib/apt/lists/*
RUN pip install --no-cache-dir tiatoolbox timm huggingface_hub s3fs

Common Mistakes

• Wrong: Using an old pixman library (<0.40) with OpenSlide Right: apt-get install libpixman-1-dev and rebuild, or use libvips ≥ 8.12 Why: Causes all-black tiles from read_rect due to a rendering bug

• Wrong: Requesting a resolution finer than the slide's native mpp Right: Use a coarser resolution, or check reader.info.mpp first Why: Triggers UserWarning: Scale > 1 and produces upsampled (interpolated) data

• Wrong: Attempting to load H-optimus-0 without accepting the gated model terms Right: Accept terms on the Hugging Face model page, then run huggingface-cli login Why: Results in OSError: 401 authentication failure

• Wrong: Using a batch size too large for GPU memory in DeepFeatureExtractor Right: Lower batch_size (16→8→4) and ensure fp16 autocast is enabled Why: Causes CUDA out-of-memory errors

• Wrong: Passing a non-pyramidal TIFF to OpenSlide Right: Convert first with vips tiffsave in.tif out.tif --tile --pyramid --compression jpeg Why: Raises OpenSlideUnsupportedFormatError because OpenSlide requires pyramidal format

• Wrong: Passing a numpy array as an external mask with shape not aligned to the WSI pyramid Right: Use reader.tissue_mask(...) directly and pass the returned reader object Why: Causes DimensionMismatchError due to resolution/shape mismatch

• Wrong: Processing PNG tiles without specifying resolution units Right: Pass units="baseline" and explicit resolution=1.0 Why: Tiles lack mpp metadata, triggering an "unknown scale" warning

• Wrong: Splitting CAMELYON17 data by slide rather than by patient Right: Split by patient_id (5-fold) per the official protocol Why: Causes patient data leakage since each patient has 5 slides

• Wrong: Skipping H-optimus-0 normalization (mean/std) when extracting features Right: Use TimmBackbone (applies normalization automatically) or apply mean/std explicitly Why: Features look random and produce low AUC without proper input normalization

• Wrong: Using annotation coordinates at the wrong pyramid level Right: ASAP XML coordinates are always at baseline level — scale them when reading at lower resolution Why: Coordinates will be off by 2× or 4× if the level mismatch is not accounted for

Minimal Dependency Set

tiatoolbox>=1.5
timm>=1.0
torch>=2.1
openslide-python
huggingface_hub

System: openslide-tools, libpixman-1-dev, libvips (for non-pyramidal TIFF conversion).

References

• TIAToolbox: Pocock et al. Commun Med 2022, https://doi.org/10.1038/s43856-022-00186-5
• H-optimus-0: Bioptimus, https://huggingface.co/bioptimus/H-optimus-0
• CAMELYON16: Bejnordi et al. JAMA 2017, https://doi.org/10.1001/jama.2017.14585
• CAMELYON17: Bandi et al. IEEE TMI 2019, https://doi.org/10.1109/TMI.2018.2867350