Predicting Helicobacter pylori Antibiotic Resistance from Routine Hematoxylin and Eosin Histopathology Using a Vision-Language Model-Guided Foundation Model Framework.

At the default threshold (0.5), sensitivity was 85.2% for clarithromycin and 98.1% for fluoroquinolones, supporting use as a screening tool.

Threshold optimization by the Youden index improved specificity to 95.9% for clarithromycin and 93.9% for fluoroquinolones, enabling rule-in risk stratification.

Decision curve analysis confirmed net clinical benefit across a broad range of threshold probabilities.