Geometry-Aware Uncertainty Coresets for Robust Visual In-Context Learning in Histopathology

Vision-Language Models (VLMs) hallucinate objects that are not present, and a growing line of work tries to curb this by feeding the model its own generated caption as auxiliary evidence -- assuming that a caption, once available, is something to consume. We show this fails: naively appending a caption can lower accuracy rather than raise it, dropping Qwen2.5-VL-3B† on HallusionBench by nearly ten points. To understand why, we build GD-Probe, a diagnostic set that pairs a global and a detail question on the same image, so that any difference in caption effect is attributable to the question alone. Caption utility proves to be a per-query property: the same caption helps global questions and harms detail ones, through a single mechanism -- an embedded caption competes with the image for attention and pulls the model's evidence onto its own text -- whose sign is set by whether the caption covers the queried content. Crucially, this regime is readable from quantities the decoder already emits, with no attention access or grounding. We turn this into GEASS (Gated Evidence-Adaptive Selective Caption Trust), a training-free, logit-level module that decides per query how much of the caption to trust, gating it by the clean path's confidence, weighting it by the entropy reduction it induces, and raising the evidence bar when the two pathways disagree. Across four VLMs and two benchmarks (POPE and HallusionBench), GEASS improves over both vanilla inference and contrastive decoding under a single fixed setting, adding only two forward passes and no parameters.

Generative vision-language models can produce fluent medical image captions but remain prone to hallucination, over-specific diagnostic claims, and factual inconsistency-serious issues in pathology. We investigate retrieval-guided generation (RGG) as a safer alternative, where captions are formed by summarizing expert text from visually similar cases rather than generated de novo. On the ARCH histopathology dataset, RGG improves semantic alignment with ground truth, achieving cosine similarity of $\approx$0.60 versus $\approx$0.47 from MedGemma, with non-overlapping confidence intervals indicating a robust gain. A pathologist-led qualitative review shows better preservation of morphology-relevant terminology and fewer unsupported diagnoses, while revealing failure modes such as concept mixing and inherited over-specific labeling. Overall, retrieval-guided captioning offers a more transparent and reliable approach with clearer opportunities for auditing than fully generative methods.

Many-shot in-context learning (ICL) lets vision-language models (VLMs) adapt from image--label demonstrations without weight updates, and is widely assumed to improve as more demonstrations are supplied. We show the opposite: as demonstrations accumulate, a subset of VLMs undergo an \emph{in-context collapse}, a sharp, sometimes catastrophic accuracy drop spanning synthetic classification, natural-image classification, and VQA benchmarks, in some models falling below chance while outputs remain well-formed. Across an open VLM panel ($0.5$B--$11$B) and a frontier model (Claude Sonnet 4.5), the collapse is graded. Two capabilities turn out to be dissociable: robustness to accumulating demonstrations and the ability to learn a novel rule in context, their combinations yield three reproducible regimes. A parameter-matched lesion-and-rescue causally localizes the collapse to the vision-language integration pathway: an adapter on the connector and early/mid layers restores genuine learning (remap accuracy $0.39!\rightarrow!0.91$ at 16 shots), while an equal-capacity adapter on the late readout does not. We propose \textsc{CircA}, whose core is a one-time integration vaccine: trained once on one synthetic task, it transfers collapse-resistance to unseen task families (chance\rightarrow$$0.71/$0.60$ on CIFAR/Fashion). The layers best for in-context integration are not the layers best for weight-based consolidation, the late readout achieves higher accuracy and less forgetting at fewer parameters. The collapse is an integration failure at the vision--language interface, correctable by a lightweight, transferable intervention.