Combining vision-language models (VLMs) with parameter-efficient fine-tuning (PEFT) offers a promising approach to few-shot whole-slide image (WSI) classification in computational pathology. This study evaluates this approach for predicting ethanol drinking status from nonhuman primate liver histology.

Adapters are evaluated against non-PEFT configurations on a subset of the Monkey Alcohol Tissue Research Resource (MATRR). All evaluated PEFT configurations achieve higher mean balanced accuracy than the non-PEFT baselines.

For example, in the four-shot setting, attention-based multiple instance learning (ABMIL) alone achieves 43.5% mean balanced accuracy, compared with 78.1% after adding an adapter. Qualitative attention analysis shows that textual pathway adaptations produce localized attention heatmaps, while visual pathway adaptations produce more diffuse ones.

A pathologist's review identified similar histological features across adaptations.