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Automatic detection of cancer metastasis from whole slide images (WSIs) is a crucial step for following patient staging and prognosis. Recent convolutional neural network based approaches are struggling with the trade-off between accuracy and computational efficiency due to the difficulty in processing large-scale gigapixel WSIs. To meet this challenge, we propose a novel Pyramidal Feature Aggregation ScanNet (PFA-ScanNet) for robust and fast analysis of breast cancer metastasis. Our method mainly benefits from the aggregation of extracted local-to-global features with diverse receptive fields, as well as the proposed synergistic learning for training the main detector and extra decoder with semantic guidance. Furthermore, a high-efficiency inference mechanism is designed with dense pooling layers, which allows dense and fast scanning for gigapixel WSI analysis. As a result, the proposed PFA …