In medical data analysis, extracting deep insights from complex, multi-modal datasets is essential for improving patient care, increasing diagnostic accuracy, and optimizing healthcare operations. However, there is currently a lack of high-quality datasets specifically designed to evaluate the ability of large multi-modal models (LMMs) to discover medical insights. In this paper, we introduce MedInsightBench, the first benchmark that comprises 332 carefully curated medical cases, each annotated with thoughtfully designed insights. This benchmark is intended to evaluate the ability of LMMs and agent frameworks to analyze multi-modal medical image data, including posing relevant questions, interpreting complex findings, and synthesizing actionable insights and recommendations. Our analysis indicates that existing LMMs exhibit limited performance on MedInsightBench, which is primarily attributed to their challenges in extracting multi-step, deep insights and the absence of medical expertise. Therefore, we propose MedInsightAgent, an automated agent framework for medical data analysis, composed of three modules: Visual Root Finder, Analytical Insight Agent, and Follow-up Question Composer. Experiments on MedInsightBench highlight pervasive challenges and demonstrate that MedInsightAgent can improve the performance of general LMMs in medical data insight discovery.
Figures & tables
Dataset
Input
Output
Task Type
Topic & Area
Multi-Step
Size
Construction Method
Spider 2.0 Lei et al. (2025)
Question
SQL Query
Text-to-SQL
Enterprise-level
Limited
632
Machine & Human-Labeled
VisEval Chen et al. (2025)
Question+Chart
Evaluation
Visual Understanding
Data Visualization
No
500+
Human-Labeled
MatPlotBench Yang et al. (2024)
Question+Table
Vis Image
Visual Generation
Data Visualization
Partial
100
Machine & Human-Labeled
InfiAgent-DABench Hu et al. (2024)
Question+Table
Answer
Data Analysis
Data Analysis
Partial
603
Machine-Labeled
InsightBench Sahu et al. (2025)
Goal+Table
Insights
Insight Discovery
Business Analysis
Extensive
100
Human-Labeled
MedRepBench Shang et al. (2026)
Image+Report
Interpretation
Medical Report Analysis
Clinical Analysis
Limited
1K+
Human-Annotated
Table 1: Comparison of MedInsightBench with existing benchmarks. Our benchmark is the first to evaluate goal-driven multi-step medical insight discovery from image-modal medical data.
Figure 1: The dataset construction pipeline of MedInsightBench. This pipeline consists of 3 steps: 1) Pathological Image Processing . WSIs are standardized and quality-checked. 2) Report Processing & Insight Extraction . Reports are converted to text, insights and questions are generated, and verified by experts. 3) Goal Generation . An overarching analysis goal is synthesized from the questions and validated for guiding the analysis.
Figure 2: Quality Comparison Between LLM Evaluation and Human Annotation.
Figure 3: Comparison of average TF - IDF cosine (TC) similarity, Self - BLEU, and Distinct - 2 diversity scores between Question and Insight in MedInsightBench.
Figure 4: Overview of our proposed agentic framework, MedInsightAgent , for goal-driven medical insight discovery. It consists of three collaborative components: (1) Visual Root Finder for image summarization and root-question generation; (2) Analytical Insight Agent for grounded question-guided analysis; and (3) Follow-Up Question Composer generates deeper follow-up questions for progressive multi-step medical reasoning.
Baselines
Insights Recall
Insights Precision
Insights F1
Insights Novelty
ROUGE-1
G-Eval
ROUGE-1
G-Eval
ROUGE-1
G-Eval
Original
Innovation
Direct Decoding (LMMs-Only)
GPT-4o
0.1799
0.2978
0.2091
0.3577
0.1934
0.3250
0.1293
0.2094
GPT-5
0.1866
0.3052
0.1851
0.3649
0.1858
0.3324
0.1322
0.2131
Deepseek-VL2
0.1816
0.3226
0.2274
0.4070
0.2019
0.3599
0.1959
0.2712
InternVL3-38B
0.1774
0.3390
0.2002
0.3993
0.1881
0.3667
0.1607
0.2553
Table 2: Performance comparison of baseline models on the MedInsightBench across insight extraction metrics.
Methods
Insights Recall
Insights Precision
Insights F1
Insights Novelty
Direct Decoding (Qwen3-VL-32B-Instruct)
0.4295
0.5372
0.4774
0.4488
MedInsightAgent (Qwen3-VL-32B-Instruct)
0.4703
0.5921
0.5242
0.4995
w/o Image-Summarization Module
0.4615 ↓ 0.0088
0.5764 ↓ 0.0157
0.5126 ↓ 0.0116
0.4780 ↓ 0.0215
w/o Web-Retrieval Module
0.4623 ↓ 0.0080
0.5739 ↓ 0.0182
0.5121 ↓ 0.0121
0.4705 ↓ 0.0290
w/o Image-Analysis Tool
0.4537 ↓ 0.0166
0.5604 ↓ 0.0317
0.5014 ↓ 0.0228
0.4842 ↓ 0.0153
w/o Follow-Up Question Composer
0.4391 ↓ 0.0312
0.5511 ↓ 0.0410
0.4888 ↓ 0.0354
0.4653 ↓ 0.0342
Table 3: Effect of each method and module within the MedInsightAgent framework. The blue arrows and values indicate the performance drop compared to the full MedInsightAgent(Qwen3-VL-32B-Instruct).
Figure 5: Comparison of novelty scores between model-generated and human-assessed insights across baselines.
Appendix figures & tables11 assets
Supplementary material from the paper’s appendix.
Appendix
Figure 6: The distribution of different Insight Types in MedInsightBench and the average token count of Question and Insight in each type of data.
Figure 7: The distribution of different difficulty levels in MedInsightBench.
Figure 8: Comparison of G-Eval scores in Insight Recall, Insight F1 , and Expert Scores in Human Evaluation.
Comparison
G-Eval F1 (Mean ± 95% CI)
p -value
MedInsightAgent
0.5242±0.0090
–
ReAct + same tools
0.5067±0.0096
0.010
Reflexion
0.5063±0.0097
0.011
CoT
0.4826±0.0105
<0.001
Qwen3-VL-32B
0.4774±0.0109
<0.001
GPT-4o
0.3250±0.0138
<0.001
Appendix
Table 4: Bootstrap significance test on the primary results ( B=10,000 ). G-Eval F1 is reported as mean ± 95% confidence interval. p -values are computed against MedInsightAgent.
Configuration
ISM
WRM
IAT
FQC
G-Eval F1
Novelty
ΔF1
MedInsightAgent
✓
✓
✓
✓
0.5242
0.4995
–
w/o ISM & WRM
×
×
✓
✓
0.4996
0.4607
−0.0246
w/o ISM & WRM & IAT
×
×
×
✓
0.4889
0.4524
−0.0353
Appendix
Table 5: Joint ablation results for analyzing interactions among the specialized tools in MedInsightAgent.
Absence of perineural invasion in the visible sections may impact staging.
Perineural invasion suggests a more aggressive tumor , which might increase the likelihood of cancer recurrence and affect treatment decisions.
Multifocal extracapsular extension and seminal vesicle invasion indicate locally advanced disease with higher recurrence risk; discuss adjuvant therapy options.
Stromal desmoplasia is present, indicating possible tumor-host interaction and invasive behavior.
A strong stromal reaction, known as desmoplasia, often indicates a more aggressive tumor behavior and higher grade in prostate cancer, potentially impacting treatment strategies and prognosis.
Case 122 : TCGA-IN-A7NT with Difficulty Level 3
Angiolymphatic invasion is present.
No definitive lymphovascular invasion observed, although detailed review and further sections may be warranted.
The presence of lymphovascular invasion can suggest a higher risk of metastasis, informing treatment decisions and prognosis.
There are poorly formed glands and irregular cell clustering, which may indicate a higher histologic grade.
The presence of pronounced cellular atypia and high mitotic rate suggests a more aggressive tumor behavior , potentially correlating with a higher risk of nodal metastasis and impacting therapeutic decisions.
Appendix
Table 6: Case study of insight discovery. We selected three cases across different difficulty levels, with the bolded statements highlighting instances where MedInsightAgent demonstrated superior performance and the underlined parts show the defects in the output of GPT-4o.
Model
Reviewed
Category A
Category B
Category C
Human Approval Rate
MedInsightAgent
30
13 (43.3%)
13 (43.3%)
4 (13.4%)
26 (86.6%)
Qwen3-VL-32B
30
8 (26.7%)
13 (43.3%)
9 (30.0%)
21 (70.0%)
Reflexion
30
9 (30.0%)
13 (43.3%)
8 (26.7%)
22 (73.3%)
Appendix
Table 7: Supplementary human audit of insights that passed the Novelty filter. Category A denotes true clinical novelty, Category B denotes clinically relevant but already known information, and Category C denotes trivial or clinically uninformative statements. The human approval rate is the proportion of insights categorized as A or B.
Method
API Calls / Sample
Avg. Input Tokens
Avg. Output Tokens
Wall-clock (s/Sample)
G-Eval F1
Direct Decoding
1
2,352
521
15.8
0.4774
CoT
1
2,685
769
27.6
0.4826
ReAct
12.4
10,907
2,854
133.4
0.5067
MedInsightAgent
32
65,372
7,692
958.9
0.5242
Appendix
Table 8: Inference cost and performance comparison across different methods. All values are averaged per sample.
Goal
Correlate histopathologic features of the tongue carcinoma with staging parameters, margin status, nodal metastasis, and HPV status to guide prognostic assessment and treatment planning.
Pathological Image
Appendix
Table 9: Goal and pathological image of Case 4 in MedInsightBench.
Insights Details
Question 1 : What is the diagnosis, location, size, and depth of invasion as documented in the pathology report for the excised tongue specimen? Insight 1 : Invasive keratinizing squamous cell carcinoma identified in the right lateral tongue dorsum and lateral tongue, approximately 2.0 cm in greatest dimension with muscle invasion. Type 1 : Diagnostic
Question 2 : Does the pathology report confirm the presence of metastatic carcinoma in a lymph node from the right neck level 2, and what is the greatest dimension measurement of the identified tumor deposit? Insight 2 : Metastatic carcinoma identified in one lymph node from right neck level 2 with a tumor deposit measuring 1.9 cm. Type 2 : Diagnostic
Question 3 : What is the status of all surgical margins regarding tumor presence in the final pathology report? Insight 3 : Final surgical margins are negative for tumor in all specimens. Type 3 : Descriptive
Question 4 : What are the specific pathologic stage descriptors for the primary tumor, regional lymph nodes, and the number of lymph nodes examined versus involved as documented in the report? Insight 4 : Pathologic staging is pT1 pN1 with 44 lymph nodes examined and 1 involved. Type 4 : Descriptive
Question 5 : What are the reported findings regarding histologic grade, extracapsular extension, perineural invasion, and bony/cartilage invasion? Insight 5 : Tumor is moderately-differentiated squamous cell carcinoma without extracapsular extension, perineural invasion, or bony/cartilage invasion. Type 5 : Descriptive
Question 6 : What were the results of HPV testing for both p16 immunohistochemistry and high risk HPV in situ hybridization? Insight 6 : HPV testing performed shows p16 negative by immunohistochemistry and high risk HPV negative by in situ hybridization. Type 6 : Descriptive
Appendix
Table 10: Insight details of Case 4 in MedInsightBench (1).
Insights Details
Question 7 : Does the pathology report indicate both the number of lymph nodes involved by metastatic carcinoma and the total number examined, along with the presence or absence of extracapsular extension? Insight 7 : Single lymph node metastasis (1/44) without extracapsular extension suggests intermediate recurrence risk; consider adjuvant therapy based on multidisciplinary discussion. Type 7 : Predictive
Question 8 : Does the pathology report confirm that all intraoperative frozen section consultations for mucosal margins were benign, indicating adequate surgical clearance? Insight 8 : All intraoperative frozen section consultations for mucosal margins were benign, confirming adequate surgical clearance. Type 8 : Evaluative
Question 9 : What are the specific benign findings and lymph node levels documented as negative for tumor in the report? Insight 9 : Additional benign findings include minor salivary gland tissue and multiple lymph node levels negative for tumor. Type 9 : Descriptive
Question 10 : What is the HPV status of the oral cavity squamous cell carcinoma as determined by testing documented in the report? Insight 10 : HPV-negative status in an oral cavity squamous cell carcinoma suggests non-HPV driven etiology; consider additional molecular profiling for treatment guidance. Type 10 : Exploratory
Appendix
Table 11: Insight details of Case 4 in MedInsightBench (2).
Multimodal Large Language Models (MLLMs) have demonstrated impressive capabilities in understanding common visual elements, largely due to their large-scale datasets and advanced training strategies. However, their effectiveness in medical applications remains limited due to the inherent discrepancies between data and tasks in medical scenarios and those in the general domain. Concretely, existing medical MLLMs face the following critical limitations: (1) limited coverage of medical knowledge beyond imaging, (2) heightened susceptibility to hallucinations due to suboptimal data curation processes, (3) lack of reasoning capabilities tailored for complex medical scenarios. To address these challenges, we first propose a comprehensive data curation procedure that (1) efficiently acquires rich medical knowledge data not only from medical imaging but also from extensive medical texts and general-domain data; and (2) synthesizes accurate medical captions, visual question answering (VQA), and reasoning samples. As a result, we build a multimodal dataset enriched with extensive medical knowledge. Building on the curated data, we introduce our medical-specialized MLLM: Lingshu. Lingshu undergoes multi-stage training to embed medical expertise and enhance its task-solving capabilities progressively. Besides, we preliminarily explore the potential of applying reinforcement learning with verifiable rewards paradigm to enhance Lingshu's medical reasoning ability. Additionally, we develop MedEvalKit, a unified evaluation framework that consolidates leading multimodal and textual medical benchmarks for standardized, fair, and efficient model assessment. We evaluate the performance of Lingshu on three fundamental medical tasks, multimodal QA, text-based QA, and medical report generation. The results show that Lingshu consistently outperforms the existing open-source multimodal models on most tasks ...
This paper introduces a new benchmark test, Medical-Checklist, for assessing medical multimodal models. The recent advancements in multimodal models have demonstrated significant potential in the field of medical vision-language tasks. However, it is becoming increasingly clear that evaluating these models' performance, whether they are applied to natural or medical images, is challenging. The critical question is whether the models can accurately understand an input image while associating it with relevant input text. To address this, Medical-Checklist imposes a binary test on the models: they are given an image and two captions, where one is correct and the other incorrect, and the model must select the correct one. The incorrect caption contains a single medical concept (word or phrase) that is inaccurately substituted from the correct caption. Although the task is simple, this simplicity enables the unified assessment of diverse multimodal models designed and learned on different principles. It also enables us to verify whether models correctly understand a wide range of medical concepts across various medical sub-domains. Medical-Checklist is designed to reduce potential biases in data and to enable evaluation of the models' ability to handle out-of-distribution inputs, which were difficult in existing datasets. When evaluating four state-of-the-art medical multimodal models with Medical-Checklist, it was revealed that despite their excellent performance in specific tasks such as Med-VQA, they may not correctly understand images, suggesting a long journey ahead for clinical application. The dataset and code will be made public upon acceptance.
Recent Multimodal Large Language Models (MLLMs) are rapidly evolving into unified understanding and generation (UAG) frameworks. However, extending these unified paradigms to the medical domain is hindered by: the absence of comprehensive training and evaluation benchmarks, and the lack of broadly validated unified medical model. To address these gaps, we present a comprehensive foundation for medical UAG. First, we construct MedUAGCorpus, the largest unified medical understanding and generation dataset to date, comprising over 6 million instances across 14 imaging modalities. Second, we introduce MedUAGBench, a systematic benchmark that expands medical generation evaluation to 12 diverse tasks under standardized protocols. Finally, leveraging these resources, we develop MedUAG, an end-to-end trained unified medical model. Extensive experiments demonstrate that MedUAG achieves strong performance across a wide array of understanding and generation tasks, establishing a competitive baseline and paving the way for next-generation medical multimodal systems.
Zijie Meng, Yuncheng Zhang, Hualiang Wang +8
Zhejiang University · Hong Kong University of Science and Technology · Tsinghua University +1