Background: Whole-slide images (WSIs) are crucial in pathology for digitizing tissue slides, enabling pathologists and AI models to analyze cancer patterns at gigapixel scale. However, their large size incorporates artifacts and non-tissue regions that slow AI processing, consume resources, and introduce errors like false positives. Tissue detection serves as the essential first step in WSI pipelines to focus on relevant areas, but deep learning detection methods require extensive manual annotations. Methods: This study benchmarks four thumbnail-level tissue detection methods—Otsu’s thresholding, K-Means clustering, our novel annotation-free Double-Pass hybrid, and GrandQC’s UNet++ on 3322 TCGA WSIs from nine cancer cohorts, evaluating accuracy, speed, and efficiency. Results: Double-Pass achieved an mIoU of 0.826—very close to the deep learning GrandQC model’s 0.871—while processing slides on a CPU in just 0.203s per slide, markedly faster than GrandQC’s 2.431s per slide on the same hardware. As an annotation-free, CPU-optimized method, it therefore enables efficient, scalable thumbnail-level tissue detection on standard workstations. Conclusions: The scalable, annotation-free Double-Pass pipeline reduces computational bottlenecks and facilitates high-throughput WSI preprocessing, enabling faster and more cost-effective integration of AI into clinical pathology and research workflows. Comparing Double-Pass against established methods, this benchmark demonstrates its novelty as a fast, robust and annotation-free alternative to supervised methods.
Ceachi et al. (Fri,) studied this question.