# PathCoT: Chain-of-Thought Prompting for Zero-shot Pathology Visual Reasoning

arXiv: https://arxiv.org/abs/2507.01029 · HTML: https://mlsanity.com/paper/2507.01029/

## Key facts

- Cited by 2 papers in the map (data through 14 Oct 2026).
- Placed in Clinical and biomedical applications, one of 17 directions in LLM reasoning.
- Builds on 9 of its 24 references that are in the map.
- First posted on arXiv 18 Jun 2025.

## Placed in

- LLM reasoning / [Clinical and biomedical applications](https://mlsanity.com/lr/clinical-and-biomedical-applications/)
- Multimodal LLMs / vision-language models / [Medical vision-language models](https://mlsanity.com/mllm/medical-vision-language-models/)

## Builds on (most cited first, 9 of 9)

- [GPT-4 Technical Report](https://mlsanity.com/paper/2303.08774/) (2023)
- [InstructBLIP: Towards General-purpose Vision-Language Models with Instruction Tuning](https://mlsanity.com/paper/2305.06500/) (2023)
- [MiniGPT-4: Enhancing Vision-Language Understanding with Advanced Large Language Models](https://mlsanity.com/paper/2304.10592/) (2023)
- [Multimodal Chain-of-Thought Reasoning in Language Models](https://mlsanity.com/paper/2302.00923/) (2023)
- [Automatic Chain of Thought Prompting in Large Language Models](https://mlsanity.com/paper/2210.03493/) (2022)
- [A Survey on Mixture of Experts in Large Language Models](https://mlsanity.com/paper/2407.06204/) (2024)
- [CoCoT: Contrastive Chain-of-Thought Prompting for Large Multimodal Models with Multiple Image Inputs](https://mlsanity.com/paper/2401.02582/) (2024)
- [MC-CoT: A Modular Collaborative CoT Framework for Zero-shot Medical-VQA with LLM and MLLM Integration](https://mlsanity.com/paper/2410.04521/) (2024)
- [Good Questions Help Zero-Shot Image Reasoning](https://mlsanity.com/paper/2312.01598/) (2023)

## Built on by (most cited first, 2 of 2)

- [Medical Reasoning in the Era of LLMs: A Systematic Review of Enhancement Techniques and Applications](https://mlsanity.com/paper/2508.00669/) (2025)
- [Beyond MedQA: Towards Real-world Clinical Decision Making in the Era of LLMs](https://mlsanity.com/paper/2510.20001/) (2025)

## Abstract (arXiv)

With the development of generative artificial intelligence and instruction tuning techniques, multimodal large language models (MLLMs) have made impressive progress on general reasoning tasks. Benefiting from the chain-of-thought (CoT) methodology, MLLMs can solve the visual reasoning problem step-by-step. However, existing MLLMs still face significant challenges when applied to pathology visual reasoning tasks: (1) LLMs often underperforms because they lack domain-specific information, which can lead to model hallucinations. (2) The additional reasoning steps in CoT may introduce errors, leading to the divergence of answers. To address these limitations, we propose PathCoT, a novel zero-shot CoT prompting method which integrates the pathology expert-knowledge into the reasoning process of MLLMs and incorporates self-evaluation to mitigate divergence of answers. Specifically, PathCoT guides the MLLM with prior knowledge to perform as pathology experts, and provides comprehensive analysis of the image with their domain-specific knowledge. By incorporating the experts' knowledge, PathCoT can obtain the answers with CoT reasoning. Furthermore, PathCoT incorporates a self-evaluation step that assesses both the results generated directly by MLLMs and those derived through CoT, finally determining the reliable answer. The experimental results on the PathMMU dataset demonstrate the effectiveness of our method on pathology visual understanding and reasoning.