FOCUS: A Subspecialty Foundation Model for Intraoperative Central Nervous System Pathology

Xing Liu, Yifan Guo, Hongtai Lv, Lei Lou, Yuyi Tan +16

Intraoperative frozen-section diagnosis of central nervous system (CNS) lesions guides surgical decisions but is challenged by artefacts, diagnostic complexity and time constraints. Most pathology foundation models have limited exposure to CNS frozen tissue. Here we present FOCUS, a subspecialty foundation model pretrained on 27,930 frozen-sections enriched for CNS tissue. FOCUS led 11 internal diagnostic and 12 biomarker-prediction tasks, with mean AUCs of 0.969 and 0.877, respectively, retaining leading performance in temporal and external cohorts. To provide more comprehensive diagnostic information, we further organized ten diagnostic tasks into a WHO-aligned diagnostic hierarchy and separately evaluated FOCUS for lymphoma detection, a critical task for intraoperative surgical decision-making. In reader assessments by six neuropathologists, FOCUS assistance enabled junior readers to approach or exceed unassisted senior readers in hierarchical diagnosis and raised junior readers' lymphoma sensitivity from 81.6% to 94.7%. FOCUS could improve diagnostic accuracy and granularity, inform lymphoma-related resection decisions and provide provisional molecular information. Such…