Zhenhao Guo

Zhenhao Guo, Rachit Saluja, Tianyuan Yao et al.

Fine-grained glomerular subtyping is central to kidney biopsy interpretation, but clinically valuable labels are scarce and difficult to obtain. Existing computational pathology approaches instead tend to evaluate coarse diseased classification under full supervision with image-only models, so it remains unclear how vision-language models (VLMs) should be adapted for clinically meaningful subtyping under data constraints. In this work, we model fine-grained glomerular subtyping as a clinically realistic few-shot problem and systematically evaluate both pathology-specialized and general-purpose vision-language models under this setting. We assess not only classification performance (accuracy, AUC, F1) but also the geometry of the learned representations, examining feature alignment between image and text embeddings and the separability of glomerular subtypes. By jointly analyzing shot count, model architecture and domain knowledge, and adaptation strategy, this study provides guidance for future model selection and training under real clinical data constraints. Our results indicate that pathology-specialized vision-language backbones, when paired with the vanilla fine-tuning, are the most effective starting point. Even with only 4-8 labeled examples per glomeruli subtype, these models begin to capture distinctions and show substantial gains in discrimination and calibration, though additional supervision continues to yield incremental improvements. We also find that the discrimination between positive and negative examples is as important as image-text alignment. Overall, our results show that supervision level and adaptation strategy jointly shape both diagnostic performance and multimodal structure, providing guidance for model selection, adaptation strategies, and annotation investment.

Zhenhao Guo, Rachit Saluja, Tianyuan Yao et al.

Vision-language models (VLMs) have shown considerable potential in digital pathology, yet their effectiveness remains limited for fine-grained, disease-specific classification tasks such as distinguishing between glomerular subtypes. The subtle morphological variations among these subtypes, combined with the difficulty of aligning visual patterns with precise clinical terminology, make automated diagnosis in renal pathology particularly challenging. In this work, we explore how large pretrained VLMs can be effectively adapted to perform fine-grained glomerular classification, even in scenarios where only a small number of labeled examples are available. In this work, we introduce Glo-VLMs, a systematic framework designed to explore the adaptation of VLMs to fine-grained glomerular classification in data-constrained settings. Our approach leverages curated pathology images alongside clinical text prompts to facilitate joint image-text representation learning for nuanced renal pathology subtypes. By assessing various VLMs architectures and adaptation strategies under a few-shot learning paradigm, we explore how both the choice of method and the amount of labeled data impact model performance in clinically relevant scenarios. To ensure a fair comparison, we evaluate all models using standardized multi-class metrics, aiming to clarify the practical requirements and potential of large pretrained models for specialized clinical research applications. As a result, fine-tuning the VLMs achieved 0.7416 accuracy, 0.9045 macro-AUC, and 0.5277 F1-score with only 8 shots per class, demonstrating that even with highly limited supervision, foundation models can be effectively adapted for fine-grained medical image classification.

Yujie Li, Yanbin Wang, Haitao Xu et al.

Adversarial attacks induce misclassification by introducing subtle perturbations. Recently, diffusion models are applied to the image classifiers to improve adversarial robustness through adversarial training or by purifying adversarial noise. However, diffusion-based adversarial training often encounters convergence challenges and high computational expenses. Additionally, diffusion-based purification inevitably causes data shift and is deemed susceptible to stronger adaptive attacks. To tackle these issues, we propose the Truth Maximization Diffusion Classifier (TMDC), a generative Bayesian classifier that builds upon pre-trained diffusion models and the Bayesian theorem. Unlike data-driven classifiers, TMDC, guided by Bayesian principles, utilizes the conditional likelihood from diffusion models to determine the class probabilities of input images, thereby insulating against the influences of data shift and the limitations of adversarial training. Moreover, to enhance TMDC's resilience against more potent adversarial attacks, we propose an optimization strategy for diffusion classifiers. This strategy involves post-training the diffusion model on perturbed datasets with ground-truth labels as conditions, guiding the diffusion model to learn the data distribution and maximizing the likelihood under the ground-truth labels. The proposed method achieves state-of-the-art performance on the CIFAR10 dataset against heavy white-box attacks and strong adaptive attacks. Specifically, TMDC achieves robust accuracies of 82.81% against $l_{\infty}$ norm-bounded perturbations and 86.05% against $l_{2}$ norm-bounded perturbations, respectively, with $ε=0.05$.