Knowledge-structured and evidence-aware semantic self-distillation for glomerular pathology foundation model

Qiming He, Jing Li, Zihan Wang, Tian Guan, Yifei Ma +22

Visual foundation models learn rich pathological morphology but lack explicit concept-level supervision. Vision--language pretraining can provide this supervision but requires costly image--text pairs. Here, we introduce GloSAGE, a semantic self-distillation framework that uses lesion profiles predicted by a pretrained visual teacher to construct structured pathology descriptions. Reliability-guided selection identifies image--text anchors, while Knowledge-Structured Pathology Text Synthesis and Evidence-Guided Negative-pair Construction account for partially observed lesions. Image--text alignment trains projection layers while retaining the frozen visual encoder; an intermediate Semantic Transfer Layer supplies features for downstream tasks. Developed on GloMillion and evaluated across seven glomerulus- and case-level cohorts, GloSAGE supported zero-shot lesion recognition, image--text retrieval, hard-negative discrimination and concept-intervention analyses. It outperformed its source visual model in most lesion-recognition tasks and improved lesion grading, while supporting competitive case-level disease classification, injury grading and baseline renal function estimation.…