Castillo, S. P.; Gautam, T.; Pinao Gonzales, K. B.; Salvatierra, M. E.; Serrano, A.; Ercan, C.; Rodriguez, B. L.; Acosta, P.; Chen, P.; Shokrollahi, Y.; Lau, A.; Kwong, L. N.; Huse, J. T.; Pan, X.; Patient Mosaic Team, ; Solis Soto, L. M.; Yuan, Y.

Selection of regions of interest (ROIs) is often a crucial step in spatial molecular profiling and many pathology tasks, with substantial implications for research reproducibility and biological interpretability. To provide a reproducible and adaptive framework for AI-guided ROI selection, we developed a modular generalist-specialist solution across spatial profiling platforms. In a cohort comprising 55 tumor types from 160 tissue donors profiled using NanoString Digital Spatial Profiling and multiplex immunofluorescence, we first established a protein-profiling reference atlas capturing compartment-specific immune, checkpoint, stromal, and proliferation patterns. We then developed an AI Specialist Task-Oriented Model for ROI Selection (ASTROS) and tested comprehensive benchmarks considering specialist-only (ASTROS), generalist-only (PLIP/GFM), and hybrid generalist-specialist strategies, showing that the latter provides a balanced tradeoff across slide-level signal preservation, pathologist-reference concordance, within-slide placement consistency, and large-slide computational efficiency. We further demonstrated the feasibility of virtual staining for ROI preview and modular ROI placement for other spatial omics technologies, Visium and Visium HD workflows. Together, these results support our proposed framework to enable ROI selection responding to unmet needs for reducing inter-rater variability, reproducibility, and versatility in spatial profiling experiments.