ALPaCA: Adapting Llama for Pathology Context Analysis to enable slide-level question answering
Bibliographic record
Abstract
Abstract Large Vision Language Models (LVLMs) are increasingly used in computational pathology for image classification, description generation, question answering and interactive diagnostics. However, most pathology LVLMs analyse small regions of interest rather than pyramidal, gigapixel-scale whole-slide images (WSIs), limiting their use for tasks requiring whole-slide assessment across sub-regions and magnification levels. Here, we present ALPaCA (Adapting Llama for Pathology Context Analysis), a slide-level LVLM framework for WSI question answering across diverse cancer types and tissue sites. ALPaCA is trained using 35,913 WSIs with curated descriptions and 341,051 question-answer pairs from TCGA and GTEx. It combines a LongFormer vision-text adaptor with a Gaussian mixture model-based prototyping adaptor and Llama3.1. ALPaCA exceeds 90% accuracy on internal close-ended benchmarks and maintains 77–82% accuracy on independent external cohorts. Expert pathologist evaluation of open-ended responses supports its slide-level reasoning capability. Additionally, ALPaCA can be fine-tuned on organ- or disease-specific datasets, supporting specialised pathology question answering.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.011 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.003 | 0.004 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.017 | 0.008 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".