# Adaptive Diagnostic Reasoning Framework for Pathology with Multimodal Large Language Models

arXiv: https://arxiv.org/abs/2511.12008 · HTML: https://mlsanity.com/paper/2511.12008/

## 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 42 of its 77 references that are in the map.
- First posted on arXiv 15 Nov 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, 30 of 42)

- [Learning Transferable Visual Models From Natural Language Supervision](https://mlsanity.com/paper/2103.00020/) (2021)
- [An Image is Worth 16x16 Words: Transformers for Image Recognition at Scale](https://mlsanity.com/paper/2010.11929/) (2020)
- [Representation Learning with Contrastive Predictive Coding](https://mlsanity.com/paper/1807.03748/) (2018)
- [GPT-4o System Card](https://mlsanity.com/paper/2410.21276/) (2024)
- [Reflexion: Language Agents with Verbal Reinforcement Learning](https://mlsanity.com/paper/2303.11366/) (2023)
- [Qwen2-VL: Enhancing Vision-Language Model's Perception of the World at Any Resolution](https://mlsanity.com/paper/2409.12191/) (2024)
- [UMAP: Uniform Manifold Approximation and Projection for Dimension Reduction](https://mlsanity.com/paper/1802.03426/) (2018)
- [Qwen-VL: A Versatile Vision-Language Model for Understanding, Localization, Text Reading, and Beyond](https://mlsanity.com/paper/2308.12966/) (2023)
- [Gemma 3 Technical Report](https://mlsanity.com/paper/2503.19786/) (2025)
- [Understanding Black-box Predictions via Influence Functions](https://mlsanity.com/paper/1703.04730/) (2017)
- [Expanding Performance Boundaries of Open-Source Multimodal Models with Model, Data, and Test-Time Scaling](https://mlsanity.com/paper/2412.05271/) (2024)
- [Root Mean Square Layer Normalization](https://mlsanity.com/paper/1910.07467/) (2019)
- [Interpretability Beyond Feature Attribution: Quantitative Testing with Concept Activation Vectors (TCAV)](https://mlsanity.com/paper/1711.11279/) (2017)
- [LLaVA-Med: Training a Large Language-and-Vision Assistant for Biomedicine in One Day](https://mlsanity.com/paper/2306.00890/) (2023)
- [Sanity Checks for Saliency Maps](https://mlsanity.com/paper/1810.03292/) (2018)
- [Attention-based Deep Multiple Instance Learning](https://mlsanity.com/paper/1802.04712/) (2018)
- [Model Cards for Model Reporting](https://mlsanity.com/paper/1810.03993/) (2018)
- [Large Language Models Are Human-Level Prompt Engineers](https://mlsanity.com/paper/2211.01910/) (2022)
- [Large Language Models as Optimizers](https://mlsanity.com/paper/2309.03409/) (2023)
- [Data Efficient and Weakly Supervised Computational Pathology on Whole Slide Images](https://mlsanity.com/paper/2004.09666/) (2020)
- [DeepSeek-VL: Towards Real-World Vision-Language Understanding](https://mlsanity.com/paper/2403.05525/) (2024)
- [Automatic Prompt Optimization with "Gradient Descent" and Beam Search](https://mlsanity.com/paper/2305.03495/) (2023)
- [How is ChatGPT's behavior changing over time?](https://mlsanity.com/paper/2307.09009/) (2023)
- [Rotary Position Embedding for Vision Transformer](https://mlsanity.com/paper/2403.13298/) (2024)
- [BiomedGPT: A Generalist Vision-Language Foundation Model for Diverse Biomedical Tasks](https://mlsanity.com/paper/2305.17100/) (2023)
- [Quilt-1M: One Million Image-Text Pairs for Histopathology](https://mlsanity.com/paper/2306.11207/) (2023)
- [BRACS: A Dataset for BReAst Carcinoma Subtyping in H&E Histology Images](https://mlsanity.com/paper/2111.04740/) (2021)
- [Exploring scalable medical image encoders beyond text supervision](https://mlsanity.com/paper/2401.10815/) (2024)
- [BACH: Grand Challenge on Breast Cancer Histology Images](https://mlsanity.com/paper/1808.04277/) (2018)
- [Transparency of Deep Neural Networks for Medical Image Analysis: A Review of Interpretability Methods](https://mlsanity.com/paper/2111.02398/) (2021)

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

- [Spatial Message Passing in Language Space for Pathology Image Interpretation](https://mlsanity.com/paper/2608.14309/) (2026)
- [See, Measure, and Reason: Learning Visually Grounded Reasoning in Pathology](https://mlsanity.com/paper/2609.34277/) (2026)

## Abstract (arXiv)

AI tools in pathology have improved screening throughput, standardized quantification, and revealed prognostic patterns that inform treatment. However, adoption remains limited because most systems still lack the human-readable reasoning needed to audit decisions and prevent errors. We present RECAP-PATH, an interpretable framework that establishes a self-learning paradigm, shifting off-the-shelf multimodal large language models from passive pattern recognition to evidence-linked diagnostic reasoning. At its core is a two-phase learning process that autonomously derives diagnostic criteria: diversification expands pathology-style explanations, while optimization refines them for accuracy. This self-learning approach requires only small labeled sets and no white-box access or weight updates to generate cancer diagnoses. Evaluated on breast and prostate datasets, RECAP-PATH produced rationales aligned with expert assessment and delivered substantial gains in diagnostic accuracy over baselines. By uniting visual understanding with reasoning, RECAP-PATH provides clinically trustworthy AI and demonstrates a generalizable path toward evidence-linked interpretation.