mlsanityData to 7 Oct 2026

Evidence-based diagnostic reasoning with multi-agent copilot for human pathology

arXiv 2506.20964 ↗First posted 26 Jun 2025cs.CV cs.AIcited by 26

On the map: LLM reasoning → Clinical and biomedical applications

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Abstract (arXiv)

Pathology is experiencing rapid digital transformation driven by whole-slide imaging and artificial intelligence (AI). While deep learning-based computational pathology has achieved notable success, traditional models primarily focus on image analysis without integrating natural language instruction or rich, text-based context. Current multimodal large language models (MLLMs) in computational pathology face limitations, including insufficient training data, inadequate support and evaluation for multi-image understanding, and a lack of autonomous, diagnostic reasoning capabilities. To address these limitations, we introduce PathChat+, a new MLLM specifically designed for human pathology, trained on over 1 million diverse, pathology-specific instruction samples and nearly 5.5 million question answer turns. Extensive evaluations across diverse pathology benchmarks demonstrated that PathChat+ substantially outperforms the prior PathChat copilot, as well as both state-of-the-art (SOTA) general-purpose and other pathology-specific models. Furthermore, we present SlideSeek, a reasoning-enabled multi-agent AI system leveraging PathChat+ to autonomously evaluate gigapixel whole-slide images (WSIs) through iterative, hierarchical diagnostic reasoning, reaching high accuracy on DDxBench, a challenging open-ended differential diagnosis benchmark, while also capable of generating visually grounded, humanly-interpretable summary reports.

Key facts. Cited by 26 papers in the map (data through 7 Oct 2026). Placed in Clinical and biomedical applications, one of 17 directions in LLM reasoning. Builds on 56 of its 117 references that are in the map. First posted on arXiv 26 Jun 2025.

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56 of 117 references.

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  1. 2025Patho-R1: A Multimodal Reinforcement Learning-Based Pathology Expert Reasoner16 May

Other references · 55

  1. 2020Language Models are Few-Shot Learnerscited by 32,199
  2. 2020An Image is Worth 16x16 Words: Transformers for Image Recognition at Scalecited by 29,915
  3. 2014Microsoft COCO: Common Objects in Contextcited by 17,498
  4. 2022Training language models to follow instructions with human feedbackcited by 15,712
  5. 2024The Llama 3 Herd of Modelscited by 14,192
  6. 2025Qwen3 Technical Reportcited by 8,195
  7. 2023Visual Instruction Tuningcited by 7,792
  8. 2025Qwen2.5-VL Technical Reportcited by 5,418
  9. 2024Qwen2.5 Technical Reportcited by 4,713
  10. 2024GPT-4o System Cardcited by 4,467
  11. 2022Flamingo: a Visual Language Model for Few-Shot Learningcited by 4,337
  12. 2024Qwen2-VL: Enhancing Vision-Language Model's Perception of the World at Any Resolutioncited by 4,151
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  1. 2024LLaVA-OneVision: Easy Visual Task Transfercited by 2,669
  2. 2024Gemma 2: Improving Open Language Models at a Practical Sizecited by 1,928
  3. 2022Large Language Models Encode Clinical Knowledgecited by 1,807
  4. 2023LLaVA-Med: Training a Large Language-and-Vision Assistant for Biomedicine in One Daycited by 1,287
  5. 2024The AI Scientist: Towards Fully Automated Open-Ended Scientific Discoverycited by 1,002
  6. 2024Cambrian-1: A Fully Open, Vision-Centric Exploration of Multimodal LLMscited by 822
  7. 2020Data Efficient and Weakly Supervised Computational Pathology on Whole Slide Imagescited by 738
  8. 2023The Dawn of LMMs: Preliminary Explorations with GPT-4V(ision)cited by 677
  9. 2018HoVer-Net: Simultaneous Segmentation and Classification of Nuclei in Multi-Tissue Histology Imagescited by 387
  10. 2023Multi-Agent Collaboration: Harnessing the Power of Intelligent LLM Agentscited by 329
  11. 2023Towards Generalist Biomedical AIcited by 286
  12. 2024AgentClinic: a multimodal agent benchmark to evaluate AI in simulated clinical environmentscited by 215
  13. 2024HuatuoGPT-Vision, Towards Injecting Medical Visual Knowledge into Multimodal LLMs at Scalecited by 194
  14. 2023Quilt-1M: One Million Image-Text Pairs for Histopathologycited by 192
  15. 2024Multimodal Whole Slide Foundation Model for Pathologycited by 156
  16. 2023Visual Language Pretrained Multiple Instance Zero-Shot Transfer for Histopathology Imagescited by 132
  17. 2021BRACS: A Dataset for BReAst Carcinoma Subtyping in H&E Histology Imagescited by 130
  18. 2024Empowering Biomedical Discovery with AI Agentscited by 117
  19. 2023Artificial Intelligence for Digital and Computational Pathologycited by 106
  20. 2020Deep Learning-based Computational Pathology Predicts Origins for Cancers of Unknown Primarycited by 89
  21. 2023Quilt-LLaVA: Visual Instruction Tuning by Extracting Localized Narratives from Open-Source Histopathology Videoscited by 84
  22. 2024PRISM: A Multi-Modal Generative Foundation Model for Slide-Level Histopathologycited by 80
  23. 2019Automated Gleason Grading of Prostate Biopsies using Deep Learningcited by 69
  24. 2021Hierarchical Graph Representations in Digital Pathologycited by 58
  25. 2025Accelerating Data Processing and Benchmarking of AI Models for Pathologycited by 58
  26. 2023PathAsst: A Generative Foundation AI Assistant Towards Artificial General Intelligence of Pathologycited by 57
  27. 2024SlideChat: A Large Vision-Language Assistant for Whole-Slide Pathology Image Understandingcited by 54
  28. 2023Towards a Visual-Language Foundation Model for Computational Pathologycited by 52
  29. 2025Molecular-driven Foundation Model for Oncologic Pathologycited by 52
  30. 2022Differentiable Zooming for Multiple Instance Learning on Whole-Slide Imagescited by 43
  31. 2024PathMMU: A Massive Multimodal Expert-Level Benchmark for Understanding and Reasoning in Pathologycited by 43
  32. 2019Similar Image Search for Histopathology: SMILYcited by 41
  33. 2019Yottixel -- An Image Search Engine for Large Archives of Histopathology Whole Slide Imagescited by 41
  34. 2022One Model is All You Need: Multi-Task Learning Enables Simultaneous Histology Image Segmentation and Classificationcited by 38
  35. 2025PathFinder: A Multi-Modal Multi-Agent System for Medical Diagnostic Decision-Making Applied to Histopathologycited by 36
  36. 2018Development and Validation of a Deep Learning Algorithm for Improving Gleason Scoring of Prostate Cancercited by 34
  37. 2024CPath-Omni: A Unified Multimodal Foundation Model for Patch and Whole Slide Image Analysis in Computational Pathologycited by 34
  38. 2021UniToPatho, a labeled histopathological dataset for colorectal polyps classification and adenoma dysplasia gradingcited by 33

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Citing papers per year: 2025: 8; 2026: 18.

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  1. 2025PathAgent: Toward Interpretable Analysis of Whole-slide Pathology Images via Large Language Model-based Agentic Reasoningcited by 18
  2. 2025A co-evolving agentic AI system for medical imaging analysiscited by 16
  3. 2025Patho-AgenticRAG: Towards Multimodal Agentic Retrieval-Augmented Generation for Pathology VLMs via Reinforcement Learningcited by 13
  4. 2025Pathology-CoT: Learning Visual Chain-of-Thought Agent from Expert Whole Slide Image Diagnosis Behaviorcited by 10
  5. 2025Navigating Gigapixel Pathology Images with Large Multimodal Modelscited by 7
  6. 2026PathReasoner-R1: Instilling Structured Reasoning into Pathology Vision-Language Model via Knowledge-Guided Policy Optimizationcited by 7
  7. 2025SurvAgent: Hierarchical CoT-Enhanced Case Banking and Dichotomy-Based Multi-Agent System for Multimodal Survival Predictioncited by 5
  8. 2025PathFound: An Agentic Multimodal Model Activating Evidence-seeking Pathological Diagnosiscited by 3
  9. 2026LAMMI-Pathology: A Tool-Centric Bottom-Up LVLM-Agent Framework for Molecularly Informed Medical Intelligence in Pathologycited by 2
  10. 2026RANGER: Sparsely-Gated Mixture-of-Experts with Adaptive Retrieval Re-ranking for Pathology Report Generationcited by 2
  11. 2025Democratising Pathology Co-Pilots: An Open Pipeline and Dataset for Whole-Slide Vision-Language Modellingcited by 1
  12. 2026Computational Pathology in the Era of Emerging Foundation and Agentic AI -- International Expert Perspectives on Clinical Integration and Translational Readinesscited by 1
14 more
  1. 2026PathMem: Toward Cognition-Aligned Memory Transformation for Pathology MLLMscited by 1
  2. 2026The Path to Self-Evolving Clinical Systems: Scaling Medical Agents from Assistance to Autonomycited by 1
  3. 2026Beyond Relevance: Bayesian Evidence Acquisition for Agentic Whole-Slide Image Reasoningcited by 1
  4. 2026Agentic Visual Reasoning in Whole-Slide Pathology Images via Active Perceptioncited by 1
  5. 2026SlideBank: A Persistent Hierarchical Evidence Bank for Consistent Whole-Slide Reasoningcited by 1
  6. 2026DALPHIN: Benchmarking Digital Pathology AI Copilots Against Pathologists on an Open Multicentric Datasetcited by 0
  7. 2026PathoSage: Towards Multi-Source Evidence Adjudication in Pathology via Experience-Aware Agentic Workflowcited by 0
  8. 2026A Multimodal Agentic Pathology Co-pilot via Evidence Grounded Reasoningcited by 0
  9. 2026How Seemingly Inconsequential Design Choices Dictate Performance of LLMs in Pathologycited by 0
  10. 2026Mitigating Batch Effects in Histopathology via Language-Mediated Robust Embedding Generationcited by 0
  11. 2026Pathologist Attention-Aligned Report Generation for Prostate Histopathologycited by 0
  12. 2026Evaluating Agentic Bioinformatics through Function, Evidence, and Validationcited by 0
  13. 2026From Patches to Evidence Balls: Class-Conditioned Evidence Retrieval for Few-Shot Whole Slide Image Classificationcited by 0
  14. 2026VIPER: An Expert-Curated Benchmark for Vision-Language Models in Veterinary Pathologycited by 0

Similar, not cited

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  1. 2025TeamPath: Building MultiModal Pathology Experts with Reasoning AI Copilots
  2. 2025A Versatile Pathology Co-pilot via Reasoning Enhanced Multimodal Large Language Model
  3. 2025PathMR: Multimodal Visual Reasoning for Interpretable Pathology Diagnosis
  4. 2026Multimodal Model for Computational Pathology:Representation Learning and Image Compression
  5. 2026PathView-Bench: Can Multimodal Large Language Models Achieve Fine-grained Multiscale Understanding of Pathology Images?
  6. 2025Adaptive Diagnostic Reasoning Framework for Pathology with Multimodal Large Language Models
  7. 2026PathNavigate: A Training-Free Pathology Agent with Surprise-Guided Scan and Shared Slide Memory for Whole-Slide Image VQA
  8. 2025PathoHR: Hierarchical Reasoning for Vision-Language Models in Pathology