Knowledge-enhanced pretraining for vision-language pathology foundation model on cancer diagnosis

Vision-language foundation models have shown great promise in computational pathology but remain primarily data-driven, lacking explicit integration of medical knowledge. We introduce knowledge-enhanced pathology (KEEP), a foundation model that systematically incorporates disease knowledge into pretraining for cancer diagnosis. KEEP leverages a comprehensive disease knowledge graph encompassing 11,454 diseases and 139,143 attributes to reorganize millions of pathology image-text pairs into 143,000 semantically structured groups aligned with disease ontology hierarchies. This knowledge-enhanced pretraining aligns visual and textual representations within hierarchical semantic spaces, enabling a deeper understanding of disease relationships and morphological patterns. Across 18 public benchmarks (over 14,000 whole-slide images) and 4 institutional rare cancer datasets (926 cases), KEEP consistently outperformed existing foundation models, showing substantial gains for rare subtypes. These results establish knowledge-enhanced vision-language modeling as a powerful paradigm for advancing computational pathology.