PathNavigate: A Training-Free Pathology Agent with Surprise-Guided Scan and Shared Slide Memory for Whole-Slide Image VQA
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Abstract (arXiv)
Whole-slide image visual question answering (WSI-VQA) frames pathology as an extreme-context search problem: to answer a free-form clinical query, a system must first navigate a gigapixel slide under a strict inspection budget to locate sparse, high-resolution evidence. Existing approaches largely fall into two paradigms: i) supervised pathology multimodal large language models (MLLMs) and agents can absorb localization and reasoning into learned modules, but they often couple navigation to task-specific supervision and retraining, limiting their practicality; ii) training-free pathology agents avoid this cost by keeping core models frozen, but often follow a question-first design, constructing the initial candidate set mainly from query-conditioned relevance. This can miss decisive morphology that is not named in the question, and force heavier inference-time scaffolding. To address this challenge, we introduce PathNavigate, a training-free pathology agent built around a scan-search-readout routine. Before question matching, PathNavigate scans the current slide at low magnification with a shared online memory module over frozen pathology features, producing a slide-specific surprise field that marks an abnormal-region pool. It then applies question-conditioned PLIP relevance only within this pool to select high-magnification search targets. Finally, it extracts local high-magnification evidence and answers with a frozen perceptor-adjudicator stack, using the same online memory as slide-level context. Experiments on WSI-VQA and SlideBench-BCNB show that the proposed scan-search-readout design improves answer accuracy and yields more interpretable evidence-selection trajectories with higher efficiency.The code is available online.
Key facts. Cited by 7 papers in the map (data through 14 Oct 2026). Builds on 31 of its 41 references that are in the map. First posted on arXiv 22 May 2026.
Builds on
31 of 41 references.
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- 2024Multimodal Whole Slide Foundation Model for Pathologycited by 162
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19 more
- 2023Quilt-LLaVA: Visual Instruction Tuning by Extracting Localized Narratives from Open-Source Histopathology Videoscited by 86
- 2024SlideChat: A Large Vision-Language Assistant for Whole-Slide Pathology Image Understandingcited by 57
- 2024PathMMU: A Massive Multimodal Expert-Level Benchmark for Understanding and Reasoning in Pathologycited by 43
- 2024WSI-LLaVA: A Multimodal Large Language Model for Whole Slide Imagecited by 40
- 2025Patho-R1: A Multimodal Reinforcement Learning-Based Pathology Expert Reasonercited by 40
- 2025PathFinder: A Multi-Modal Multi-Agent System for Medical Diagnostic Decision-Making Applied to Histopathologycited by 39
- 2024GSCo: Towards Generalizable AI in Medicine via Generalist-Specialist Collaborationcited by 34
- 2024WSI-VQA: Interpreting Whole Slide Images by Generative Visual Question Answeringcited by 34
- 2024CPath-Omni: A Unified Multimodal Foundation Model for Patch and Whole Slide Image Analysis in Computational Pathologycited by 34
- 2023WsiCaption: Multiple Instance Generation of Pathology Reports for Gigapixel Whole-Slide Imagescited by 31
- 2025CPathAgent: An Agent-based Foundation Model for Interpretable High-Resolution Pathology Image Analysis Mimicking Pathologists' Diagnostic Logiccited by 29
- 2025PathAgent: Toward Interpretable Analysis of Whole-slide Pathology Images via Large Language Model-based Agentic Reasoningcited by 19
- 2025A co-evolving agentic AI system for medical imaging analysiscited by 17
- 2025Patho-AgenticRAG: Towards Multimodal Agentic Retrieval-Augmented Generation for Pathology VLMs via Reinforcement Learningcited by 13
- 2025SurvAgent: Hierarchical CoT-Enhanced Case Banking and Dichotomy-Based Multi-Agent System for Multimodal Survival Predictioncited by 5
- 2026Act Like a Pathologist: Tissue-Aware Whole Slide Image Reasoningcited by 5
- 2025Multimodal Retrieval-Augmented Generation with Large Language Models for Medical VQAcited by 3
- 2025YpathRAG:A Retrieval-Augmented Generation Framework and Benchmark for Pathologycited by 2
- 2025Libra-MIL: Multimodal Prototypes Stereoscopic Infused with Task-specific Language Priors for Few-shot Whole Slide Image Classificationcited by 2
Built on by
Citing papers per year: 2026: 7.
7 papers.
- 2026Agentic Visual Reasoning in Whole-Slide Pathology Images via Active Perceptioncited by 1
- 2026SlideBank: A Persistent Hierarchical Evidence Bank for Consistent Whole-Slide Reasoningcited by 1
- 2026PathoArgus: Advancing Evidence-Grounded Long-Context Visual Reasoning across Gigapixel Whole-Slide and Multi-Slide Case Contextscited by 0
- 2026Can Protein-Derived Knowledge Improve Pathology Foundation Models?cited by 0
- 2026Modeling Whole-Slide Images as Dynamic Tumor Microenvironment Fieldscited by 0
- 2026PathPilot: An Adaptive Question-Conditioned Multi-Magnification Navigation Agent for Whole-Slide Image Analysiscited by 0
- 2026PlanPath: Exploration-Guided Orchestration for Patient-Level Pathology Reasoningcited by 0
- 2026PlanPath: Exploration-Guided Orchestration for Patient-Level Pathology Reasoning13 Oct 2026
- 2026PathPilot: An Adaptive Question-Conditioned Multi-Magnification Navigation Agent for Whole-Slide Image Analysis12 Oct 2026
- 2026Modeling Whole-Slide Images as Dynamic Tumor Microenvironment Fields28 Sep 2026
- 2026Can Protein-Derived Knowledge Improve Pathology Foundation Models?27 Sep 2026
- 2026SlideBank: A Persistent Hierarchical Evidence Bank for Consistent Whole-Slide Reasoning31 Aug 2026
- 2026PathoArgus: Advancing Evidence-Grounded Long-Context Visual Reasoning across Gigapixel Whole-Slide and Multi-Slide Case Contexts18 Aug 2026
- 2026Agentic Visual Reasoning in Whole-Slide Pathology Images via Active Perception9 Aug 2026
Similar, not cited
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- 2024Path-RAG: Knowledge-Guided Key Region Retrieval for Open-ended Pathology Visual Question Answering
- 2025Navigating Gigapixel Pathology Images with Large Multimodal Models
- 2025Democratising Pathology Co-Pilots: An Open Pipeline and Dataset for Whole-Slide Vision-Language Modelling
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- 2025Evidence-based diagnostic reasoning with multi-agent copilot for human pathology
- 2026ReinPath: A Multimodal Reinforcement Learning Approach for Pathology
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- 2025Efficient Whole Slide Pathology VQA via Token Compression