# PathFinder: A Multi-Modal Multi-Agent System for Medical Diagnostic Decision-Making Applied to Histopathology

arXiv: https://arxiv.org/abs/2502.08916 · HTML: https://mlsanity.com/paper/2502.08916/

## Key facts

- Cited by 39 papers in the map (data through 14 Oct 2026).
- Placed in Medical and scientific domain agents, one of 16 directions in LLM agents and tool use.
- Builds on 31 of its 58 references that are in the map.
- First posted on arXiv 13 Feb 2025.

## Placed in

- LLM agents and tool use / [Medical and scientific domain agents](https://mlsanity.com/agents/medical-and-scientific-domain-agents/)

## Builds on (most cited first, 30 of 31)

- [U-Net: Convolutional Networks for Biomedical Image Segmentation](https://mlsanity.com/paper/1505.04597/) (2015)
- [The Llama 3 Herd of Models](https://mlsanity.com/paper/2407.21783/) (2024)
- [Exploring the Limits of Transfer Learning with a Unified Text-to-Text Transformer](https://mlsanity.com/paper/1910.10683/) (2019)
- [LoRA: Low-Rank Adaptation of Large Language Models](https://mlsanity.com/paper/2106.09685/) (2021)
- [LLaMA: Open and Efficient Foundation Language Models](https://mlsanity.com/paper/2302.13971/) (2023)
- [MobileNetV2: Inverted Residuals and Linear Bottlenecks](https://mlsanity.com/paper/1801.04381/) (2018)
- [Squeeze-and-Excitation Networks](https://mlsanity.com/paper/1709.01507/) (2017)
- [GPT-4o System Card](https://mlsanity.com/paper/2410.21276/) (2024)
- [Improved Baselines with Visual Instruction Tuning](https://mlsanity.com/paper/2310.03744/) (2023)
- [AutoGen: Enabling Next-Gen LLM Applications via Multi-Agent Conversation](https://mlsanity.com/paper/2308.08155/) (2023)
- [Improving Factuality and Reasoning in Language Models through Multiagent Debate](https://mlsanity.com/paper/2305.14325/) (2023)
- [LLaVA-Med: Training a Large Language-and-Vision Assistant for Biomedicine in One Day](https://mlsanity.com/paper/2306.00890/) (2023)
- [Attention-based Deep Multiple Instance Learning](https://mlsanity.com/paper/1802.04712/) (2018)
- [TransMIL: Transformer based Correlated Multiple Instance Learning for Whole Slide Image Classification](https://mlsanity.com/paper/2106.00908/) (2021)
- [Dual-stream Multiple Instance Learning Network for Whole Slide Image Classification with Self-supervised Contrastive Learning](https://mlsanity.com/paper/2011.08939/) (2020)
- [Scaling Vision Transformers to Gigapixel Images via Hierarchical Self-Supervised Learning](https://mlsanity.com/paper/2206.02647/) (2022)
- [Agent Hospital: A Simulacrum of Hospital with Evolvable Medical Agents](https://mlsanity.com/paper/2405.02957/) (2024)
- [Quilt-1M: One Million Image-Text Pairs for Histopathology](https://mlsanity.com/paper/2306.11207/) (2023)
- [LLM Multi-Agent Systems: Challenges and Open Problems](https://mlsanity.com/paper/2402.03578/) (2024)
- [Quilt-LLaVA: Visual Instruction Tuning by Extracting Localized Narratives from Open-Source Histopathology Videos](https://mlsanity.com/paper/2312.04746/) (2023)
- [A graph-transformer for whole slide image classification](https://mlsanity.com/paper/2205.09671/) (2022)
- [How Far Are We on the Decision-Making of LLMs? Evaluating LLMs' Gaming Ability in Multi-Agent Environments](https://mlsanity.com/paper/2403.11807/) (2024)
- [SlideChat: A Large Vision-Language Assistant for Whole-Slide Pathology Image Understanding](https://mlsanity.com/paper/2410.11761/) (2024)
- [PathAlign: A vision-language model for whole slide images in histopathology](https://mlsanity.com/paper/2406.19578/) (2024)
- [PathGen-1.6M: 1.6 Million Pathology Image-text Pairs Generation through Multi-agent Collaboration](https://mlsanity.com/paper/2407.00203/) (2024)
- [An Interactive Agent Foundation Model](https://mlsanity.com/paper/2402.05929/) (2024)
- [HIGT: Hierarchical Interaction Graph-Transformer for Whole Slide Image Analysis](https://mlsanity.com/paper/2309.07400/) (2023)
- [PathM3: A Multimodal Multi-Task Multiple Instance Learning Framework for Whole Slide Image Classification and Captioning](https://mlsanity.com/paper/2403.08967/) (2024)
- [Augmenting Pathologists with NaviPath: Design and Evaluation of a Human-AI Collaborative Navigation System](https://mlsanity.com/paper/2302.07309/) (2023)
- [Semantics-Aware Attention Guidance for Diagnosing Whole Slide Images](https://mlsanity.com/paper/2404.10894/) (2024)

## Built on by (most cited first, 30 of 39)

- [From LLM Reasoning to Autonomous AI Agents: A Comprehensive Review](https://mlsanity.com/paper/2504.19678/) (2025)
- [MedAgent-Pro: Towards Evidence-based Multi-modal Medical Diagnosis via Reasoning Agentic Workflow](https://mlsanity.com/paper/2503.18968/) (2025)
- [A Survey of Agentic Reasoning for Large Language Models: Towards Recursively Self-Improving and Collective Agents](https://mlsanity.com/paper/2601.12538/) (2026)
- [CPathAgent: An Agent-based Foundation Model for Interpretable High-Resolution Pathology Image Analysis Mimicking Pathologists' Diagnostic Logic](https://mlsanity.com/paper/2505.20510/) (2025)
- [A Survey of Personalization: From RAG to Agent](https://mlsanity.com/paper/2504.10147/) (2025)
- [Evidence-based diagnostic reasoning with multi-agent copilot for human pathology](https://mlsanity.com/paper/2506.20964/) (2025)
- [CT-Agent: A Multimodal-LLM Agent for 3D CT Radiology Question Answering](https://mlsanity.com/paper/2505.16229/) (2025)
- [PathAgent: Toward Interpretable Analysis of Whole-slide Pathology Images via Large Language Model-based Agentic Reasoning](https://mlsanity.com/paper/2511.17052/) (2025)
- [Sherlock: Reliable and Efficient Agentic Workflow Execution](https://mlsanity.com/paper/2511.00330/) (2025)
- [Towards Multi-Agent Reasoning Systems for Collaborative Expertise Delegation: An Exploratory Design Study](https://mlsanity.com/paper/2505.07313/) (2025)
- [Navigating Gigapixel Pathology Images with Large Multimodal Models](https://mlsanity.com/paper/2511.19652/) (2025)
- [PathNavigate: A Training-Free Pathology Agent with Surprise-Guided Scan and Shared Slide Memory for Whole-Slide Image VQA](https://mlsanity.com/paper/2605.23559/) (2026)
- [MTBBench: A Multimodal Sequential Clinical Decision-Making Benchmark in Oncology](https://mlsanity.com/paper/2511.20490/) (2025)
- [Content Generation Models in Computational Pathology: A Comprehensive Survey on Methods, Applications, and Challenges](https://mlsanity.com/paper/2505.10993/) (2025)
- [SurvAgent: Hierarchical CoT-Enhanced Case Banking and Dichotomy-Based Multi-Agent System for Multimodal Survival Prediction](https://mlsanity.com/paper/2511.16635/) (2025)
- [3DMedAgent: Unified Perception-to-Understanding for 3D Medical Analysis](https://mlsanity.com/paper/2602.18064/) (2026)
- [Act Like a Pathologist: Tissue-Aware Whole Slide Image Reasoning](https://mlsanity.com/paper/2603.00667/) (2026)
- [PathFLIP: Fine-grained Language-Image Pretraining for Versatile Computational Pathology](https://mlsanity.com/paper/2512.17621/) (2025)
- [QCAgent: An agentic framework for quality-controllable pathology report generation from whole slide image](https://mlsanity.com/paper/2603.01647/) (2026)
- [PathFound: An Agentic Multimodal Model Activating Evidence-seeking Pathological Diagnosis](https://mlsanity.com/paper/2512.23545/) (2025)
- [LAMMI-Pathology: A Tool-Centric Bottom-Up LVLM-Agent Framework for Molecularly Informed Medical Intelligence in Pathology](https://mlsanity.com/paper/2602.18773/) (2026)
- [MMNavAgent: Multi-Magnification WSI Navigation Agent for Clinically Consistent Whole-Slide Analysis](https://mlsanity.com/paper/2603.02079/) (2026)
- [Computational Pathology in the Era of Emerging Foundation and Agentic AI -- International Expert Perspectives on Clinical Integration and Translational Readiness](https://mlsanity.com/paper/2603.05884/) (2026)
- [NuNext: Reframing Nucleus Detection as Next-Point Detection](https://mlsanity.com/paper/2603.07098/) (2026)
- [The Path to Self-Evolving Clinical Systems: Scaling Medical Agents from Assistance to Autonomy](https://mlsanity.com/paper/2607.11175/) (2026)
- [Do Pathology Vision-Language Models Truly See Pathology?](https://mlsanity.com/paper/2607.21065/) (2026)
- [Beyond Relevance: Bayesian Evidence Acquisition for Agentic Whole-Slide Image Reasoning](https://mlsanity.com/paper/2608.05757/) (2026)
- [MedBLINK: Probing Basic Perception in Multimodal Language Models for Medicine](https://mlsanity.com/paper/2508.02951/) (2025)
- [Which Tool Response Should I Trust? Tool-Expertise-Aware Chest X-ray Agent with Multimodal Agentic Learning](https://mlsanity.com/paper/2602.21517/) (2026)
- [Policy-Driven CT-Agent: Modeling Phase-Aware Diagnostic Control for Clinically Consistent CT Reasoning](https://mlsanity.com/paper/2607.10748/) (2026)

## Abstract (arXiv)

Diagnosing diseases through histopathology whole slide images (WSIs) is fundamental in modern pathology but is challenged by the gigapixel scale and complexity of WSIs. Trained histopathologists overcome this challenge by navigating the WSI, looking for relevant patches, taking notes, and compiling them to produce a final holistic diagnostic. Traditional AI approaches, such as multiple instance learning and transformer-based models, fail short of such a holistic, iterative, multi-scale diagnostic procedure, limiting their adoption in the real-world. We introduce PathFinder, a multi-modal, multi-agent framework that emulates the decision-making process of expert pathologists. PathFinder integrates four AI agents, the Triage Agent, Navigation Agent, Description Agent, and Diagnosis Agent, that collaboratively navigate WSIs, gather evidence, and provide comprehensive diagnoses with natural language explanations. The Triage Agent classifies the WSI as benign or risky; if risky, the Navigation and Description Agents iteratively focus on significant regions, generating importance maps and descriptive insights of sampled patches. Finally, the Diagnosis Agent synthesizes the findings to determine the patient's diagnostic classification. Our Experiments show that PathFinder outperforms state-of-the-art methods in skin melanoma diagnosis by 8% while offering inherent explainability through natural language descriptions of diagnostically relevant patches. Qualitative analysis by pathologists shows that the Description Agent's outputs are of high quality and comparable to GPT-4o. PathFinder is also the first AI-based system to surpass the average performance of pathologists in this challenging melanoma classification task by 9%, setting a new record for efficient, accurate, and interpretable AI-assisted diagnostics in pathology. Data, code and models available at https://pathfinder-dx.github.io/