Multiple instance learning (MIL) has emerged as a reliable paradigm that has propelled the integration of computational pathology (CPath) into clinical histopathology. However, despite significant advancements, current MIL approaches continue to face challenges due to inadequate spatial information representation resulting from the disorder of the original whole slide images (WSIs). To address this limitation, we first demonstrate the importance of prioritized scanning within the structured state space models (SSM). We introduce a MIL framework that incorporates spatial information, termed Prioritized Scanning MIL (PSMIL). PSMIL primarily comprises two branches and a fusion block. The first branch, known as the spatial branch, incorporates potential spatial information into the patch sequence using the original 2D positions and employs SSM to model the spatial features of the WSI. The second branch, referred to as the cross-spatial branch, utilizes a significance scoring block along with SSM to harness feature relationships among similar instances across spatial locations. Finally, a lightweight feature fusion block integrates the outputs of both branches, facilitating more comprehensive feature utilization. Extensive experiments on 5 popular datasets and 3 downstream tasks strongly demonstrate that PSMIL surpasses the state-of-the-art MIL methods significantly, up to 5.26% ACC improvements for cancer sub-typing. Our code is available at https://github.com/YuqiZhang-Buaa/PSMIL.
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