# See, Measure, and Reason: Learning Visually Grounded Reasoning in Pathology

arXiv: https://arxiv.org/abs/2609.34277 · HTML: https://mlsanity.com/paper/2609.34277/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Placed in Clinical and biomedical applications, one of 17 directions in LLM reasoning.
- Builds on 29 of its 40 references that are in the map.
- First posted on arXiv 28 Sep 2026.

## Placed in

- LLM reasoning / [Clinical and biomedical applications](https://mlsanity.com/lr/clinical-and-biomedical-applications/)

## Builds on (most cited first, 29 of 29)

- [LoRA: Low-Rank Adaptation of Large Language Models](https://mlsanity.com/paper/2106.09685/) (2021)
- [DeepSeekMath: Pushing the Limits of Mathematical Reasoning in Open Language Models](https://mlsanity.com/paper/2402.03300/) (2024)
- [Qwen3-VL Technical Report](https://mlsanity.com/paper/2511.21631/) (2025)
- [InternVL3: Exploring Advanced Training and Test-Time Recipes for Open-Source Multimodal Models](https://mlsanity.com/paper/2504.10479/) (2025)
- [Are We on the Right Way for Evaluating Large Vision-Language Models?](https://mlsanity.com/paper/2403.20330/) (2024)
- [BLINK: Multimodal Large Language Models Can See but Not Perceive](https://mlsanity.com/paper/2404.12390/) (2024)
- [PathVQA: 30000+ Questions for Medical Visual Question Answering](https://mlsanity.com/paper/2003.10286/) (2020)
- [HoVer-Net: Simultaneous Segmentation and Classification of Nuclei in Multi-Tissue Histology Images](https://mlsanity.com/paper/1812.06499/) (2018)
- [Vision language models are blind: Failing to translate detailed visual features into words](https://mlsanity.com/paper/2407.06581/) (2024)
- [Machine Mental Imagery: Empower Multimodal Reasoning with Latent Visual Tokens](https://mlsanity.com/paper/2506.17218/) (2025)
- [PanNuke Dataset Extension, Insights and Baselines](https://mlsanity.com/paper/2003.10778/) (2020)
- [Latent Visual Reasoning](https://mlsanity.com/paper/2509.24251/) (2025)
- [Self-Rewarding Vision-Language Model via Reasoning Decomposition](https://mlsanity.com/paper/2508.19652/) (2025)
- [Lizard: A Large-Scale Dataset for Colonic Nuclear Instance Segmentation and Classification](https://mlsanity.com/paper/2108.11195/) (2021)
- [Quilt-LLaVA: Visual Instruction Tuning by Extracting Localized Narratives from Open-Source Histopathology Videos](https://mlsanity.com/paper/2312.04746/) (2023)
- [Chain-of-Visual-Thought: Teaching VLMs to See and Think Better with Continuous Visual Tokens](https://mlsanity.com/paper/2511.19418/) (2025)
- [MIRAGE: The Illusion of Visual Understanding](https://mlsanity.com/paper/2603.21687/) (2026)
- [Perception-R1: Advancing Multimodal Reasoning Capabilities of MLLMs via Visual Perception Reward](https://mlsanity.com/paper/2506.07218/) (2025)
- [PathMMU: A Massive Multimodal Expert-Level Benchmark for Understanding and Reasoning in Pathology](https://mlsanity.com/paper/2401.16355/) (2024)
- [Patho-R1: A Multimodal Reinforcement Learning-Based Pathology Expert Reasoner](https://mlsanity.com/paper/2505.11404/) (2025)
- [NuCLS: A scalable crowdsourcing, deep learning approach and dataset for nucleus classification, localization and segmentation](https://mlsanity.com/paper/2102.09099/) (2021)
- [Perceptual-Evidence Anchored Reinforced Learning for Multimodal Reasoning](https://mlsanity.com/paper/2511.18437/) (2025)
- [Are They the Same? Exploring Visual Correspondence Shortcomings of Multimodal LLMs](https://mlsanity.com/paper/2501.04670/) (2025)
- [Beyond Outcome Verification: Verifiable Process Reward Models for Structured Reasoning](https://mlsanity.com/paper/2601.17223/) (2026)
- [PathReasoner-R1: Instilling Structured Reasoning into Pathology Vision-Language Model via Knowledge-Guided Policy Optimization](https://mlsanity.com/paper/2601.21617/) (2026)
- [PathFound: An Agentic Multimodal Model Activating Evidence-seeking Pathological Diagnosis](https://mlsanity.com/paper/2512.23545/) (2025)
- [PathView-Bench: Can Multimodal Large Language Models Achieve Fine-grained Multiscale Understanding of Pathology Images?](https://mlsanity.com/paper/2607.28318/) (2026)
- [Adaptive Diagnostic Reasoning Framework for Pathology with Multimodal Large Language Models](https://mlsanity.com/paper/2511.12008/) (2025)
- [Do Pathology Vision-Language Models Truly See Pathology?](https://mlsanity.com/paper/2607.21065/) (2026)

## Abstract (arXiv)

Pathological assessment relies on recognizing fine-grained visual details in histological images. Vision-language models (VLMs) increasingly support pathology interpretation, yet their ability to perceive these details remains inadequate. This weakness leads to inaccurate cellular observations that can persist even when final answers are correct. In this paper, we propose ASPECT to improve visually grounded reasoning through explicit supervision of cellular appearance and abundance. ASPECT trains intermediate visual tokens through pathology feature reconstruction, cell feature alignment, and count supervision. Three-stage supervised fine-tuning teaches the model to perceive, generate visual tokens, and reason, followed by reinforcement learning that rewards answer correctness and consistency with reported measurements. We also introduce PathoVernier, a benchmark of 759 expert-reviewed questions from five pathology datasets covering four cellular composition tasks. It evaluates both final answers and intermediate measurements to expose errors hidden by answer accuracy. On PathoVernier, ASPECT achieves relative accuracy gains of approximately 19.2% over the strongest baseline, Gemini-3.1-Pro, and 99.3% over its Qwen3-VL-8B backbone, while reducing RAWR, which measures counting errors within correct responses, by 28.1% and 42.7%, respectively. ASPECT also improves over its backbone on three external pathology benchmarks covering classification and question answering beyond cellular composition tasks.