Medical Image Benchmarks

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20 papers in the last four weeks, up 25% on the four weeks before. 0.2% of all new papers.

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Latest papers 237

Oct 8, 2026cs.CV

PathLang: A Language-Centered Benchmark for Vision-Language Models in Computational Pathology

Pathology vision-language models (VLMs) have shown strong visual perception ability, but their robustness in the language domain remains poorly characterized. Existing pathology VLM benchmarks largely rely on canonical closed-set prompts or perturb only generic templates, treating language as a fixed evaluation component rather than a variable axis of model behavior. In clinical practice, however, diagnostic language varies across reports, institutions, and candidate diagnoses. We introduce PathLang, a language-centered and clinically grounded zero-shot benchmark. PathLang holds the underlying slides, ground-truth labels, and image-text evaluation direction fixed while systematically varying only the diagnostic language, so that performance differences reflect how a diagnosis is phrased rather than what is imaged. The language variation follows how pathologists actually rephrase diagnoses (terminology, specificity, and reporting style), and all prompts and candidate pools are validated by six board-certified pathologists. PathLang covers four task families: (1) zero-shot classification with image-text alignment analysis, (2) cross-modal retrieval, (3) paraphrase robustness, including semantic-equivalence paraphrases, length and reporting-style variation, and prompt ensembling, and (4) open-vocabulary diagnosis retrieval over four candidate pools with distinct forms of semantic competition. Across nine VLMs and five public datasets spanning four organs, we find that performance is highly sensitive to clinically equivalent paraphrases, varies substantially across forms of semantic competition, and that image-text alignment quality does not necessarily translate into inter-class separability. We release the prompt corpus, candidate pools, pre-computed text embeddings, and evaluation code at https://anonymous.4open.science/r/PathLang.

Fanqi Cheng, Kuo Gong, Shangke Liu +15

New York University, New York, NY, USA · Columbia University, New York, NY, USA · Weill Cornell Medicine, New York, NY, USA +9

VLM Evaluation Medical VLMs Medical Image Benchmarks Computational Pathology Cross-Modal Retrieval

Oct 8, 2026cs.AI

MedBenchAgent: Towards Systematic Automation of Medical VLM Benchmark Construction

Large-scale construction of medical vision-language model (VLM) benchmarks is increasingly feasible with richly annotated imaging datasets and large language models (LLMs), yet existing automation largely focuses on generating evaluation items within predefined benchmark specifications. We study the broader problem of automatically deriving the specification itself: what to evaluate, which annotations support each task, and how to translate this evidence into reliable evaluation items. We formulate benchmark construction as constrained compilation, in which the benchmark specification is progressively derived from evaluation requirements, heterogeneous annotations, and medical knowledge. Based on this formulation, we introduce MedBenchAgent, a multi-agent framework with a Benchmark Intermediate Representation (BIR) that encodes task definitions, evidence mappings, evaluation protocols, and item specifications across construction stages. MedBenchAgent separates planning, which derives and verifies the specification, from instantiation, which constructs and audits items under the locked specification. MedBenchAgent achieves a Task-Space F1 of 90.9%, outperforming direct task induction (79.2-80.0%) and prior-guided induction (85.1%); 994 of 1,000 sampled items from correctly identified tasks pass human audit. We further demonstrate portability to a specialized medical domain and evaluate twelve VLMs, revealing task- and setting-specific variation obscured by aggregate scores. These results establish constrained compilation as a scalable and auditable framework for medical VLM benchmark construction beyond question generation.

Yulin Fu, Junren Wang, Guangjing Yang +5

Beijing University of Posts and Telecommunications · West China Hospital · Sichuan Provincial Engineering Research Center of Intelligent Diagnosis and Treatment of Breast Diseases

Medical Image Benchmarks VLM Evaluation Medical VLMs

Oct 7, 2026cs.CV

Performance at What Cost? A Sustainability-Aware Performance Index for Cell and Nucleus Instance Segmentation

Pretrained models for cell and nuclear instance segmentation differ substantially in architecture, pretraining data and objectives, parameter count, inference strategy, adaptation requirements, postprocessing pipeline, and computational demand. Large pretrained and foundation models are increasingly adopted because of their strong zero-shot capabilities, but their use also imposes greater energy consumption, memory requirements, computational demands, adaptation costs, and operational carbon emissions. Whether these additional demands are justified by meaningful gains in segmentation performance remains unclear. We address this question by introducing the Sustainability-Aware Performance Index (SAPI), a configurable metric that combines segmentation performance, energy consumption, and model size. We benchmark 19 pretrained and foundation models across six CellBinDB datasets under zero-shot inference and evaluate 16 fine-tunable models using few-shot adaptation with both frozen encoder and full-model fine-tuning. We estimate energy consumption for GPU, CPU, and RAM using software-based monitoring tools. Our results show that larger and more computationally demanding models do not consistently achieve proportionate improvements in segmentation quality. While few-shot adaptation benefits several models, the gains and resource costs vary considerably across architectures, datasets, and adaptation strategies, causing SAPI-based rankings to differ from rankings based on performance alone. This study provides a practical framework for comparing segmentation models more comprehensively and supports more computationally accessible and environmentally responsible model selection in biomedical image analysis.

Eiram Mahera Sheikh, Alaa Tharwat, Wolfram Schenck

Department of Engineering and Mathematics, Bielefeld University of Applied Sciences and Arts, Interaktion 1, 33619 Bielefeld

Instance Segmentation Cost-Aware Inference Medical Image Benchmarks Zero-Shot Medical Image Segmentation Few-Shot Medical Image Segmentation

Oct 7, 2026cs.CV

A Multi-Source Ultrasound Benchmark Revealing the Limits of Contemporary Self-Supervised Anomaly Detection Methods

Self-supervised anomaly detection is a promising paradigm for medical ultrasound, as normal images are often easier to obtain than exhaustive annotations of all possible pathologies. However, most existing evaluations are limited to a single anatomy or task, making it unclear whether models learn a robust notion of normal ultrasound appearance or only a source-specific representation. We introduce the SADUSI benchmark, a multi-source ultrasound dataset designed to train and evaluate anomaly detection methods across a broad range of anatomical regions, views, and acquisition protocols. The goal of SADUSI is to provide a diverse normal ultrasound distribution and a benchmark for visible structural anomalies that can be assessed from single images. We evaluate representative self-supervised anomaly detection methods and find that current approaches struggle in this setting. In particular, reconstruction-based diffusion methods such as AnoDDPM and DeCo-Diff achieve pixel-level AUROC values of 0.56-0.72 and maximum F1 scores of 0.10-0.26, indicating limited separation of pathology from normal image regions. Feature-based PatchCore variants perform better, reaching pixel-level AUROC values of 0.76-0.83, but remain limited with maximum F1 scores of 0.14-0.40. These findings suggest that broad multi-source ultrasound anomaly detection remains an open challenge and that SADUSI can serve as a resource for developing methods that generalize beyond anatomy-specific settings.

Marco Riedenauer, Daniel Kienzle, Pratik Mayekar +1

University of Augsburg

Medical Image Anomaly Detection Unsupervised Anomaly Detection Medical Image Benchmarks Ultrasound Imaging Reconstruction-Based Anomaly Detection

Oct 6, 2026cs.CV

Multi-Dataset Diagnostic Utility of Clinical Visual Concepts in AI Systems for Dermatology

The clinical integration of AI systems in digital dermatology relies heavily on human trust. Clinically interpretable visual concepts can act as intermediate representations enhancing trust and reliability. However, research in this domain is currently limited by scattered, heterogeneous dataset annotations. In this work, we introduce SkinLex, a harmonized dataset of 48 clinical morphological attributes across four public datasets (SkinCon, DermaCon-IN, MM-Skin, and PASSION) for a total of 20,411 records. Supervised nine-partition classification of skin conditions shows that limiting features to specific visual groups, like shapes or colors alone, reduces diagnostic accuracy. Bootstrapped backward elimination reveals that the set of 48 visual concepts has some degree of redundancy for algorithmic nine-partition diagnosis on the examined dataset. This demonstrates that coarse diagnosis on the selected dataset requires a relatively small but varied combination of clinical concepts, and motivates further research to improve concept taxonomy. Results can be translated into clinical benefits by reducing inputs for concept-based models, improving efficiency for annotation and modeling, and further enhancing interpretability. Code and prompt templates are available at https://github.com/Digital-Dermatology/SkinLex.

Linda Wermelinger, Simone Lionetti, Fabian Gröger +6

University of Basel · Lucerne University of Applied Sciences and Arts · University Hospital of Basel

Skin Lesion Classification Explainable Medical Image Analysis Medical Image Benchmarks Image Classification

Oct 4, 2026cs.CV

WILLIE: A Unified Framework and Benchmark for Wound Classification, Segmentation, and Localization

Chronic wound management affects over 8.2 million patients in the United States and imposes substantial clinical and economic burden. Clinical wound assessment commonly involves three coupled tasks: identifying wound type, delineating wound boundaries, and localizing the wound region for measurement and monitoring. Despite this clinical coupling, existing machine learning approaches typically address wound classification, segmentation, and localization using separate models. We present WILLIE, a unified framework and benchmark for wound classification, segmentation and localization that enables systematic evaluation of multi-task wound analysis under a common protocol. WILLIE harmonizes three public wound datasets into a shared benchmark and compares unified models across three scaling configurations against 10 single-task baselines. The best model achieves 91.88% classification accuracy, 91.41% Dice, and 96.23% [email protected] while producing all three outputs in a single forward pass. Beyond aggregate performance, our results show that segmentation-derived localization outperforms dedicated detection baselines in this benchmark, suggesting that box-based localization may be unnecessary for spatially coherent wound targets. Our findings highlight that effective multi-task learning in healthcare imaging depends not only on shared representations, but also on task formulation, compatibility, and benchmark design.

Gopi Trinadh Maddikunta, Shannan Hamlin, Hsin-Mei Chen +2

Department of Computer Science University of Houston Houston, Texas, USA · Houston Methodist Academic Institute Houston Methodist Hospital System Houston, Texas, USA

Multi-Task Learning Medical Image Segmentation Medical Image Localization Medical Image Benchmarks

Oct 1, 2026cs.CV

MIRTO: a registration-gated, multiverse-tested evaluation protocol for unsupervised anomaly segmentation in brain MRI

Unsupervised anomaly detection (UAD) methods for brain MRI are ranked by a single score, yet that score rests on choices that are rarely reported: how each anomaly map is aligned with the reference, how and on which data the threshold is set, and which false-positive budget, metric, aggregation and lesion definition are used. We present MIRTO, an evaluation protocol that makes these choices explicit and measures their effect. It gates the geometry of every comparison with a registration check and label-free diagnostics of known power, sets thresholds on validation data alone and reports the false-positive volume actually realised on test, repeats each comparison over 15,552 defensible evaluation pipelines, and attaches paired subject-bootstrap intervals with multiplicity control. Applied to four UAD methods trained on the same healthy data and tested on 312 BraTS 2020 subjects, MIRTO showed that an axis-order mismatch between stored maps and the reference lowered a diffusion model's voxel AUROC from 0.873 to 0.583 whilst barely moving its slice-level AUROC. Within each metric, the method explained at least 0.95 of the variance in voxel AUROC and AUPRC and 0.77 in Dice, but only 0.14 in lesion sensitivity, where the lesion definition and hit criterion dominated. A Dice advantage that was significant at validation thresholds vanished at equal realised false-positive burden, and an exact identity attributes it to threshold transfer. A training-free change to REFLECT's latent aggregation raised Dice at equal burden by 0.052. Nine hypotheses were tested against explicit criteria; because the same cohort served to develop the protocol, all inference is exploratory.

Negin Kafee Hernashki, Soumick Chatterjee

Università degli Studi di Milano, Milan, Italy · Politecnico di Milano, Milan, Italy · Human Technopole, Milan, Italy +1

Anomaly Localization Unsupervised Anomaly Detection Medical Image Benchmarks Brain MRI

Oct 1, 2026cs.CV

CineMR: Tool-Integrated Vision-Language Reasoning for Quantitative Cardiac MRI Assessment

Cardiovascular magnetic resonance (CMR), including cine imaging, is a reference standard for the noninvasive assessment of cardiac morphology and ventricular function. Cine CMR interpretation integrates qualitative visual assessment with quantitative measurements of ventricular volumes, ejection fraction, myocardial mass, wall thickness, and regional wall motion. Current medical vision-language models (VLMs) cannot reliably derive quantitative measurements from multidimensional cine images without analysis tools. We present CineMR, a tool-augmented VLM that invokes cardiac image-analysis tools and integrates their outputs into interleaved reasoning for quantitative CMR assessment. We also construct a multi-cohort visual question answering benchmark covering quantitative metric extraction, multiclass diagnosis, and differential diagnosis, together with tools for segmentation, phase selection, volumetry, morphometry, and regional wall motion analysis. CineMR is trained with supervised fine-tuning (SFT) on tool-interaction traces followed by Group Relative Policy Optimization (GRPO) with conditional tool-use rewards. On the multi-cohort cine CMR benchmark, CineMR achieves 35.9% pass@1 and 58.9% pass@4, compared with 1.5% pass@1 for the Qwen3-VL-8B backbone and 0.0% and 7.0% pass@1 for LLaVA-Med v1.5 and MedGemma-4B, respectively. Correct tool invocation reaches 99.8% after GRPO, up from 78.9% after SFT. Live tool outputs improve ventricular measurement accuracy by 20.4--23.7% over direct model predictions, and removing all tools reduces pass@1 from 35.9% to 27.9%. These results highlight the importance of reliable tool use for quantitative cine CMR reasoning and support CineMR as a promising approach for assistive cardiac image assessment. Code, benchmark resources, and model weights are available at https://github.com/AI-MIND-Lab/CineMR.

Kunyang Li, Hai Nguyen, Joshua Lowe +6

Institute for Artificial Intelligence, University of Central Florida · Department of Clinical Sciences, College of Medicine, University of Central Florida · Nemours Cardiac Center, Nemours Children’s Hospital, Florida +1

Tool Use in VLMs Medical VQA VLM Reasoning Medical Image Benchmarks Cardiac MRI

Oct 1, 2026cs.CV

The RSNA Intracranial Aneurysm (RSNA-ICA) Dataset

Intracranial aneurysm rupture is associated with substantial morbidity and mortality, yet aneurysm detection remains challenging, particularly for small lesions and on routine non-angiographic imaging examinations. To support the development and evaluation of artificial intelligence (AI) algorithms for intracranial aneurysm detection and localization, the Radiological Society of North America (RSNA), in collaboration with the American Society of Neuroradiology (ASNR), the Society of Neurointerventional Surgery (SNIS), and the European Society of Neuroradiology (ESNR), curated the RSNA Intracranial Aneurysm (RSNA-ICA) Dataset. Developed for the 2025 RSNA Intracranial Aneurysm Detection Challenge, RSNA-ICA is a large, publicly available, expert-annotated dataset comprising 7202 CTA, MRA, and MRI series from 4278 adult patients collected across 21 institutions in 12 countries spanning five continents. The dataset includes 2566 CTA, 2166 MRA, and 2470 MRI series from patients with and without intracranial saccular aneurysms, providing substantial geographic and imaging diversity. Expert annotations indicate both aneurysm presence and location, and 178 series additionally include three-dimensional segmentations of challenge-defined vascular locations. RSNA-ICA was used to develop and evaluate algorithms in the 2025 RSNA Intracranial Aneurysm Detection Challenge. Of the 7202 image series, 5041 are publicly available through MIRA (https://mira.rsna.org/dataset/7), while the remainder were used for challenge public and private test sets. The dataset is freely available to the research community for noncommercial use and provides a comprehensive resource for advancing AI-based aneurysm detection across both angiographic and routine neuroimaging examinations.

Maria Correia de Verdier, Rachit Saluja, Jason Sho +37

Department of Surgical Sciences, Section of Neuroradiology, Uppsala University, Uppsala, Sweden · Department of Electrical and Computer Engineering, Cornell University and Cornell Tech, New York, NY, USA · Department of Radiology, Weill Cornell Medicine, New York, NY, USA +37

Medical Image Anomaly Detection Medical Image Localization Medical Image Benchmarks

Sep 30, 2026cs.CV

Scores That Hold, Benchmarks That Leak: Measuring Dataset Contamination in Public Brain-Tumor MRI Classification

Automated classification of brain tumors from MRI is a heavily published application of deep learning in medical imaging, with reported accuracies on public benchmarks routinely exceeding 98%. However, accuracy does not capture a critical dimension of benchmark quality: dataset integrity, defined as the independence of test from training data at the image, patient, and acquisition-source levels. We introduce a three-layer contamination framework comprising duplicate, patient, and source-label leakage to assess the public corpora on which this literature rests. We audit the three most widely used corpora against a chest-radiograph negative control and quantify each layer's effect on measured performance across nine architectures and three evaluation conditions. Contamination is severe at every layer: 28.8% of the dominant corpus's official test split has a near-twin in its own training split, a second corpus leaks 22.3% of its test images byte-identically, 95.5% of traceable test images share a patient with training, and file-header features containing no anatomy separate tumor from no-tumor at 0.959 balanced accuracy, at parity with fine-tuned ResNet backbones. The unexpected result is that removing every identified leaked test image leaves balanced accuracy essentially unchanged: stable performance after deduplication does not establish benchmark integrity. Our findings establish dataset integrity as a distinct, measurable axis of benchmark quality that a stable leaderboard cannot certify. For biomedical research, reported accuracy on these corpora alone does not establish that a model has learned to recognize tumors rather than exploit dataset-specific cues. We release the contaminated-file lists, recovered patient identifiers, and deduplicated splits.

Bhanu Prakash Vangala, Sowmya Guda, Latha Peddi +1

Department of Electrical Engineering and Computer Science, University of Missouri, Columbia, MO 65211 USA · Government Degree College (Autonomous), Siddipet, Telangana 502103, India · Amar Biotech Private Limited, Kondapur, Hyderabad, Telangana 500084, India

Data Leakage Benchmark Contamination Brain Tumor Classification Medical Image Benchmarks Brain MRI

Sep 30, 2026cs.CV

Learning Where to Look: Anatomical Grounding and Guided Attention for Cardiac MRI Vision-Language Models

Cardiac magnetic resonance imaging (CMR) enables assessment of cardiac anatomy, ventricular function, and myocardial tissue characteristics. Clinicians interpret these images by identifying cardiac structures and focusing on the regions relevant to each clinical question, motivating anatomically guided vision-language models (VLMs). Yet CMR-specific supervision for anatomical localisation and clinical question answering remains limited. To address this gap, we investigate fine-grained CMR visual question answering through anatomical grounding and guided attention. We construct 128,915 anatomical-grounding and 42,799 clinical QA pairs across short-axis cine, late gadolinium enhancement, and long-axis cine. These datasets support anatomical recognition, localisation, and clinical assessment without requiring paired reports for individual training images. To help the model learn where to look, we introduce Cardiac Anatomy-Routed Attention (CARA), which selects predicted anatomical priors according to the question and guides decoder attention with learned task-specific strengths. Combining anatomical grounding pretraining with CARA yields our model, CARA-VL. Experiments demonstrate CARA-VL's strengths in clinical assessment and regional localisation across CMR imaging settings, with promising generalization to an external clinical cohort. Together, our data and method provide a practical framework for studying and advancing cardiac visual understanding in VLMs. We will release the QA data derived from public datasets upon publication.

Bangwei Guo, Xiao Chen, Boris Mailhe +8

Rutgers University, NJ, USA · United Imaging Intelligence, Boston, MA, USA · University of Texas Southwestern Medical Center, TX, USA +1

Medical VQA Medical Image Grounding Medical Image Benchmarks Cardiac MRI

Sep 29, 2026cs.CV

Evaluation Choices Shape Biomedical ML Claims: A Pediatric Pneumonia Benchmark Case Study

Biomedical machine learning papers often compress model performance into one headline number. That number can look like a property of the model even when it depends strongly on how the benchmark was evaluated. We study this problem on the widely used Kermany pediatric chest radiograph dataset using nine image classifiers and a controlled evaluation protocol. Under the same protocol, the eight pretrained backbones differ by only 0.026 AUROC. In contrast, changing whether the backbone is frozen or fine-tuned changes AUROC by 0.044 on average, and changing the decision threshold changes balanced accuracy by 0.090 on average. The official test split is also measurably different from the training pool: a partition classifier distinguishes them at AUC 0.697, rising to 0.898 for normal radiographs. Most strikingly, a classifier using only file properties, with no image anatomy, reaches 0.992 balanced accuracy within the training pool but falls to 0.496 on the official test split. Validation-fitted thresholds and calibration also transfer imperfectly. These results show that a high benchmark score can support different conclusions when the split, training policy, threshold, metric, calibration, and uncertainty are not communicated with it. We end with a seven-item reporting recommendation in which each item is tied to an effect measured in the study

Bhanu Prakash Vangala, Sowmya Guda, Latha Peddi +1

University of Missouri · Government Degree College · Amar Bio Tech Pvt Ltd

Data Leakage Chest X-Ray Classification Shortcut Learning Medical Image Benchmarks

Sep 29, 2026cs.CV

Merlin Plus: A Large-Scale, Multi-Cancer, Image-Mask-Report Dataset

Multi-cancer segmentation in computed tomography (CT) is fundamentally limited by the scarcity of tumor masks across different organs. We present Merlin Plus, the first large-scale CT dataset with radiologist-created tumor masks across 9 organs. Merlin Plus extends the Merlin dataset by adding 1,153 per-voxel tumor masks and longitudinal metadata. To create these tumor masks, we developed a report-based active-learning framework in which radiology reports identify tumor cases for annotation and support training of a tumor segmentation model. The model generates initial masks, which radiologists review and correct to produce the final masks, reducing annotation burden while maintaining high-quality annotations. Besides tumor masks, the longitudinal metadata in Merlin Plus enables temporal modeling of cancer progression. By directly addressing the major bottleneck of limited multi-cancer segmentation masks, Merlin Plus supports scalable multi-organ cancer detection, segmentation, and longitudinal analysis in CT. Dataset is available at: https://github.com/MrGiovanni/MerlinPlus

Pedro R. A. S. Bassi, Wenxuan Li, Szymon Plotka +10

Johns Hopkins University · Harvard Medical School · Massachusetts General Hospital +5

Medical Image Segmentation Computed Tomography Medical Image Benchmarks

Sep 28, 2026cs.CV

Generative AI-Based Data Augmentation for Oral Lesion Classification: The PhotoMOCI Dataset and Benchmark

Early detection of oral cancer via photographic imaging presents a promising avenue for large-scale oral cavity screening. However, the development of robust deep learning models is frequently hampered by the scarcity of high-quality, annotated datasets. To address this limitation, a novel and well-curated resource, the Photographic Multi-purpose Oral Cancer Imaging (PhotoMOCI) dataset, is introduced for developing models across multiple diagnostic tasks in oral oncology. Then, a comprehensive benchmark study was conducted to investigate how various data augmentation strategies influence the performance of image classifiers. Our analysis spans different generative AI frameworks, evaluating the efficacy of traditional methods against advanced generative approaches, including Generative Adversarial Networks (GANs) and Diffusion Models (DMs). Additionally, we propose the Synthetic Image Filter (SIF), a mechanism to select specific samples based on two auxiliary models: Synthetic Proxy Classifier to ensure samples are representative of the target class and Synthetic Image Detector to verify they appear realistic, thereby selecting only the high-utility images that contribute to improving downstream performance. Across the evaluated datasets and classifiers, the best SIF-filtered setup improves accuracy over traditional augmentation in all cases, with gains of +1.73% and +2.35% on PhotoMOCI and +2.38% and +2.08% on KOCD for ResNet50 and ViT, respectively. Our findings reveal that while the direct application of generative data augmentation may yield performance drops, the integration of SIF, considering (i) how synthetic data looks real and (ii) how it reflects the discriminative features of the belonging class, provides a simple yet effective mechanism to filter out synthetic samples that confuse the classifier during training.

Marco Parola, Mario G. C. A. Cimino, Sabrina Senatore

Aalborg University, Denmark. · University of Pisa, Italy. · University of Salerno, Italy.

Synthetic Data Augmentation Medical Imaging Medical Image Classification Medical Image Benchmarks

Sep 26, 2026cs.CV

Multimodal LLMs Outperform Pathology Foundation Models in Cross-Domain Histological Similarity

State-of-the-art pathology foundation models, trained on millions of histology tiles, can fail to preserve tissue similarity when comparisons cross slide or institution boundaries. We show that general-purpose multimodal LLMs, without being trained as pathology foundation models, consistently outperform these specialized models in cross-domain histological similarity judgments. Using a relative similarity framework that we release as the MOSAIC (Model Similarity Assessment across Institutions and Cohorts) benchmark, we evaluate 17 models across 6 datasets and find that pathology encoders often rank same-institution, different-disease tiles as more similar than same-disease, different-institution tiles, a clinically dangerous failure mode invisible to standard within-domain evaluations. LLMs appear less susceptible to this failure, likely because they perform semantic visual comparison of morphology and tissue architecture rather than relying on shortcut features tied to acquisition context. Scaling training data does not resolve the problem for pathology encoders, implicating the learning objective rather than data coverage. Our results expose a fundamental robustness gap in current pathology foundation models and establish multimodal LLMs as a viable alternative for cross-institutional retrieval, dataset harmonization, and multi-site quality control. Code and data will be released upon acceptance.

Yishu Zhang, Yun Li, Daiwei Zhang

University of North Carolina at Chapel Hill

Multimodal Robustness Multimodal Large Language Models Pathology Foundation Models Multimodal Model Evaluation Medical Image Benchmarks

Sep 26, 2026cs.CV

EyeVQA: Benchmarking Ophthalmic Vision-Language Models from Recognition to Spatial Grounding

Vision-language models (VLMs) have shown increasing potential for medical image understanding, yet their capabilities in ophthalmic imaging remain insufficiently characterized. Existing ophthalmic datasets are typically designed for individual diseases or specialized tasks, making it difficult to systematically evaluate whether VLMs can move beyond disease recognition toward comparative reasoning and fine-grained spatial grounding. We introduce EyeVQA, a unified visual question answering benchmark for comprehensive evaluation of ophthalmic VLMs. EyeVQA is constructed from 21 available ophthalmic datasets and contains 20,000 question-answer pairs spanning six disease groups and seven question types: Single-Choice, Multi-Select, Variable-Select, True-False, Ranking, Point Location, and Bounding Box. Gold answers are deterministically derived from source-provided diagnoses, severity grades, clinical findings, segmentation masks, bounding boxes, and anatomical landmarks, enabling reproducible evaluation without relying on model-generated annotations. Notably, 44.5% of the questions require reasoning across multiple images, extending evaluation beyond conventional single-image medical VQA. We benchmark fourteen representative general-purpose, scientific, and medically specialized VLMs under a unified zero-shot protocol. The best-performing model only achieves an overall score of 62.8, while substantial gaps remain in spatial grounding and cross-task generalization. These results highlight the limitations of current VLMs in comprehensive ophthalmic visual understanding and establish EyeVQA as a diagnostic benchmark for developing more reliable and spatially grounded ophthalmic multimodal models. The project page is available at https://github.com/PKUTHM/EyeVQA.

Gujie Shao, Zixun Xie, Xuechun Xing +7

VLM Evaluation Medical VQA Vision-Language Grounding Medical Image Benchmarks

Sep 23, 2026cs.CV

UltraBench 2: Towards Robust Evaluation of Vision Foundation Models on Ultrasound

Benchmarking is an increasingly critical part of research in machine learning and the domains where it is applied, including healthcare. Yet, despite the steady development of new ultrasound foundation models in recent years, the development of well-designed benchmarks to evaluate them has lagged behind. This deficiency has led to fragmented and inconsistent evaluations of competing models, making it difficult to measure progress. To address this issue, we introduce UltraBench 2, a comprehensive benchmark with wide anatomical and task coverage, and a focus on standardization, reproducibility, and ease-of-use. Using this benchmark, we compare existing vision foundation models for ultrasound image analysis. Our analyses demonstrate that ultrasound-specific pretraining still leads on classification, but that state-of-the-art general-purpose models have drawn level on segmentation.

Ashwath Radhachandran, Adam Tupper, Christian Gagné +1

Bioengineering Department, University of California, Los Angeles · Institut Intelligence et Données (IID), Université Laval Mila – Quebec AI Institute · Radiological Sciences Department, UCLA David Geffen School of Medicine

Ultrasound Image Segmentation Medical Imaging Foundation Models Vision Foundation Models Medical Image Classification Ultrasound Imaging Medical Image Benchmarks

Sep 22, 2026cs.CV

Faithful Faithfulness Evaluations: Challenges & Pitfalls Learned from a Breast MRI Case Study

Saliency maps are widely used to explain deep learning predictions in medical imaging, yet visually plausible explanations do not necessarily reflect a model's true decision process and may therefore mislead clinicians. We investigate this problem using a Vision Transformer-based breast MRI classifier trained on the ODELIA Breast MRI Challenge dataset and evaluate multiple saliency methods, including Last-layer Attention, Attention Rollout, Grad-SAM, Gradient Attention Rollout, GMAR, Grad-CAM, and HiResCAM. Our study highlights two often-overlooked challenges in perturbation-based faithfulness evaluation. First, method rankings depend strongly on the perturbation strategy, varying across intensity-based perturbations and transformer-based attention masking. Second, benchmarking saliency methods requires distinguishing between class-specific and class-agnostic explanations. To enable fair comparisons, we introduce non-class-specific variants of gradient-based methods and evaluate both settings separately. Across protocols, Grad-CAM and Gradient Attention Rollout consistently emerged as the strongest class-specific methods, although their relative ranking depended on the evaluation design. These findings expose important limitations of current saliency-based explainability approaches and highlight the need for more robust and standardized evaluation frameworks for trustworthy clinical AI systems.

Peachapong Poolpol, Henrik H. J. Detjen, Eike Petersen

Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany · Deggendorf Institute of Technology, Deggendorf, Germany

Perturbation-Based Feature Attribution Saliency Map Evaluation Medical Image Benchmarks

Sep 21, 2026cs.CV

Brain Metastases Segmentation for BraTS 2026 Task 1: A Multi-Architecture Comparison

Brain metastases are the most common intracranial malignancy, occurring in roughly 30% of patients with primary solid tumors and carrying a median survival near 5.9 months. Automated segmentation is critical for treatment planning and volumetric monitoring, but metastases are frequently small, numerous, and heterogeneous in size within a single patient. We compare a plain nnU-Net baseline, a Residual Encoder Large (ResEncL) variant, region-based training, and a Primus transformer model for BraTS-METS 2026 Task 1, using patient-grouped cross-validation to prevent leakage from the longitudinal UCSD subset. Primus (label-based) is our strongest individual model by aggregate DSC/NSD, achieving 0.710/0.761 (ET), 0.742/0.785 (TC), 0.683/0.689 (WT), and 0.531/0.436 (RC). ResEncL trails Primus on aggregate DSC/NSD but achieves substantially higher lesion-wise F1 (e.g. ET: 0.452 vs. 0.052); a probability-averaging ensemble of the two only partially preserves ResEncL's F1 advantage (ET lesion-wise F1: 0.064). We further report three postprocessing and label-reconstruction pitfalls we believe generalize beyond this challenge. Code is available at https://github.com/mahdiislam79/BraTS_METS_2026.

Mahdi Islam, Musarrat Tabassum

Center for Computational & Data Sciences, Independent University, Bangladesh · Department of Electrical and Electronic Engineering, Independent University, Bangladesh · Independent Researcher

U-Net Medical Image Segmentation 3D Medical Image Segmentation Medical Image Benchmarks Brain Tumor Segmentation

Sep 17, 2026cs.CV

ERCPMP-Gx: Endoscopic Image and Video Dataset for Morphological, Histopathological, and Genomic Characterization of Colorectal Polyposis

Hereditary polyposis syndromes can be precursor lesions to colorectal cancer and are associated with a broad spectrum of extracolonic tumors. Early identification and accurate classification of these syndromes are essential for timely diagnosis, individualized patient management, and targeted surveillance strategies for affected families. However, public endoscopic datasets are largely organized around the individual sporadic polyp, and none links the polyposis phenotype to histopathology and germline findings at the patient level. Here, we present ERCPMP-Gx, an endoscopic, histopathological, and genomic dataset developed to support the application of artificial intelligence (AI) in the recognition, characterization, and classification of colorectal polyposis. Most procedures were performed using the Olympus EVIS X1 system with white-light endoscopy (WLE), narrow-band imaging (NBI), magnifying NBI (M-NBI), and NBI with near focus modes, yielding 160 images and accompanying video clips. Approximately eighty percent of cases represent clinically and/or genetically confirmed hereditary polyposis syndromes (PG), including familial adenomatous polyposis (FAP), Peutz-Jeghers syndrome (PJS), juvenile polyposis syndrome (JPS), and ganglioneuroma syndrome (GNS), while the remaining twenty percent comprise non-hereditary polyps and polyp-mimicking lesions with overlapping morphological features (Non-PG), included to support differential classification. Each released record is linked, where available, to standardized endoscopic annotations, representative histopathology, and clinically reported germline findings, forming an AI-ready, patient-level annotation framework. The dataset is publicly accessible at Mendeley (https://doi.org/10.17632/nzyfc544bx.2). For the latest updates and further information, readers are referred to the DataBioX website: https://databiox.com.

Zahra Ghaffari, Massih Bahar, Mojgan Forootan +2

Shahid Beheshti University of Medical Sciences, Tehran, Iran. · Familial & Hereditary Cancers Institute, Tehran, Iran. · Shiraz University of Medical Sciences, Shiraz, Iran. +1

Endoscopy Medical Image Benchmarks

Sep 14, 2026cs.CV

Benchmarking Intra-Patient 3D Deformable Multimodal Image Registration

Multimodal image registration is a key component of many clinical workflows, yet it remains challenging because corresponding anatomical structures often exhibit substantially different image intensities across modalities. In this work, we present a comprehensive benchmark of intra-patient 3D multimodal deformable registration methods across three datasets covering different anatomical regions and difficulty levels, including both synthetic deformation recovery and real clinical scenarios. We evaluate classical optimization-based approaches and modern learning-based methods, including recent deep learning and foundation models, using complementary metrics: Average Dice similarity coefficient (DSC), average 95th-percentile Hausdorff distance (HD95), and a modality-independent structural similarity measure based on the MIND self-similarity context (MIND-SSC). Results show high variability across datasets, with learning-based methods demonstrating superior performance on large synthetic benchmarks, while only limited improvements are observed in real pelvic registration. A key finding of this study is the consistent disagreement between geometric metrics (DSC, HD95) and image-based similarity metrics (MIND-SSC), highlighting that improved overlap does not necessarily imply better global multimodal correspondence. Furthermore, anatomy-guided approaches achieve the highest overlap scores but exhibit degraded performance outside of segmented regions, revealing a trade-off between label-driven alignment and global structural coherence. Overall, our results indicate that no current method achieves robust performance across anatomies and modalities. We demonstrate that intra-patient 3D multimodal registration requires multi-criteria evaluation, including deformation-based metrics, and remains an open problem.

Matteo Barbieri, Giammarco La Barbera, Juan Pablo De La Plata +3

IMAG2, Institut IMAGINE, Université Paris Cité, Paris, France · Replico SAS, Paris, France · Université Paris Cité, Department of Pediatric Surgery, Hôpital Necker Enfants-Malades, Assistance Publique–Hôpitaux de Paris (AP-HP), Paris, France +2

Medical Image Registration Cross-Modal Image Registration Deformable Image Registration Medical Image Benchmarks

Sep 14, 2026cs.CV

Assessing nnU-Net Generalization across Brain Tumor Populations in BraTS-GoAT 2026

BraTS-GoAT evaluates tumor segmentation across heterogeneous populations. We trained a conventional 3D nnU-Net on 1,351 labeled cases using five-fold cross-validation and 1,000 epochs per fold. The final predictor averaged all folds and applied test-time mirroring. On pooled official validation, global DSC values were 0.7805, 0.8288, and 0.8854 for enhancing tumor (ET), tumor core (TC), and whole tumor (WT). Under matched fold-0 inference, mean regional Dice decreased from 0.9058 on source out-of-fold (OOF) cases to 0.8310 on pooled validation (difference--0.0747). Mirroring gave small single-fold gains but no clear ensemble benefit; a residual-encoder alternative reached 0.8282 mean Dice. In labeled OOF predictions, failure cases had substantially smaller reference ET volumes; after adjustment for ET and WT volume, lower Dice remained associated with more disconnected ET components and a smaller fraction of ET contained in the largest component.

Tristan Kirscher, Vivian Metzger, Philippe Meyer +1

ICube, Institut Strauss · ICube Laboratory, CNRS UMR 7357, University of Strasbourg, Strasbourg, France · Institut Strauss +2

Neural Network Generalization U-Net 3D Medical Image Segmentation Medical Image Benchmarks Brain Tumor Segmentation

Sep 11, 2026cs.CV

Pre- and Post-Treatment Brain Metastases Segmentation Using nnU-Net with Post-Processing for BraTS 2026

Brain metastases exhibit high inter-lesion variability in size, enhancement pattern, and post-treatment appearance, making volumetric segmentation of both pre- and post-treatment cases the central challenge of the BraTS 2026 Task 1 (Brain Metastases). We build a pragmatic pipeline on a 5-fold nnU-Net ResEnc-L ensemble, in which each fold is trained independently for 1,000 epochs with the standard Dice + cross-entropy loss on 1,296 four-modality training cases. This ensemble is followed by a rule-based post-processing cascade tuned for the lesion-wise Dice similarity coefficient (LW-DSC), a detection-oriented metric that behaves very differently from the traditional global Dice. The final pipeline reaches an LW-DSC of 0.733 / 0.751 / 0.713 / 0.549 on the enhancing tumour (ET), tumour core (TC), whole tumour (WT), and resection cavity (RC) sub-regions on the official validation leaderboard. Rather than trusting these leaderboard gains, we audit every post-processing stage with a five-fold out-of-fold (OOF) analysis with no model-training leakage over all 1,296 training cases, scored with the official BraTS evaluation code (BraTS_evaluation): it confirms two stages as robust, per-fold-consistent improvements while the third improves only the leaderboard and does not reproduce out-of-fold. We further provide a mechanistic analysis of the LW-DSC metric that explains why recall-recovering post-processing carries low risk whereas component deletion does not, and we report thirteen negative results spanning loss engineering, alternative backbones, and inference-time settings, several of which run counter to widely held intuitions. Source code is released under Apache-2.0 at https://github.com/hornbeamliu/brats2026-met.

Haobin Liu, Xin Wang

College of Software, Jilin University, Changchun, China · Key Laboratory of Symbolic Computation and Knowledge Engineering of Ministry of Education, Jilin University, Changchun, China

Medical Image Segmentation Medical Image Benchmarks Brain Tumor Segmentation

Sep 8, 2026cs.CV

Evaluation Principles for MRI-MRA Registration in Trigeminal Neuralgia: An ROI-Centered Neurovascular Benchmark

Preoperative evaluation of trigeminal neuralgia (TN) often requires joint interpretation of structural MRI, which depicts the trigeminal nerve and surrounding cisternal anatomy, and time-of-flight MRA, which highlights vascular structures. Although MRI-MRA fusion is clinically attractive for visualizing neurovascular compression, this task is poorly captured by conventional whole-brain registration evaluation because the clinically relevant target is a small trigeminal ROI, vessel annotations are partial and clinically focused, local TOF-MRA contrast is variable, and field-of-view mismatch can limit deformable alignment. We formulate TN MRI-MRA fusion as an ROI-centered neurovascular registration-evaluation problem and construct a benchmark from 149 patients with clinician-annotated bilateral trigeminal ROIs. Six representative registration pipelines were evaluated using local image-based metrics, segmentation-derived vessel-localization metrics, prediction-volume analysis, and contrast- and FOV-stratified comparisons. Conventional evaluation summaries were often misleading: local image similarity, vessel-background separability, and downstream vessel localization did not co-rank methods; one-sided vessel distances were strongly affected by predicted vessel extent under partial annotations; and local MRA contrast determined when vessel-separability metrics were informative. Deformable refinement provided only a small, FOV-dependent benefit over affine alignment, while reader review showed that locally favorable vessel distances could coexist with globally implausible registrations. These findings indicate that TN MRI-MRA registration should be evaluated as a local, vessel-aware, contrast-sensitive, and FOV-aware visualization task rather than as generic multimodal brain registration. Our code is publicly available at https://github.com/jhuldr/TN-Reg-Benchmark.

Xupeng Zhang, Xihang Wang, Michael Xie +6

Department of Electrical and Computer Engineering and Data Science and AI Institute, Johns Hopkins University, Baltimore, MD 21218, USA · Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA · Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21287, USA

Medical Image Registration Neuroimaging Cross-Modal Image Registration Medical Image Benchmarks

Sep 7, 2026cs.AI

A visual large language foundational model for medical image recognition using clinician-contributed online resources

Large language models (LLMs) have demonstrated strong capabilities across diverse domains, showing considerable potential in medicine. However, their application in medical settings remains limited by the scarcity of visual question answering (VQA) datasets that capture clinical reasoning and explicit image-text alignment. Here, we leverage de-identified medical images and expert commentaries shared through clinician-oriented online resources. By combining an advanced LLM with clinician-in-the-loop verification, we established a rigorous pipeline to construct ThoughtMed-1M, a long-form medical VQA dataset containing over one million VQA pairs and designed to capture structured clinical reasoning and medical image-text alignment. To demonstrate its utility, we developed a FOundational LLM Trained on ThoughtMed-1M (FOLTMed). FOLTMed achieved state-of-the-art performance across 42 medical VQA benchmark datasets, with a macro accuracy of 85.4 percent. It also generated more clinically coherent responses on the ThoughtMed-1M test set, outperforming state-of-the-art models by 3 to 5 percent across factuality and similarity metrics, highlighting a scalable paradigm for advancing research on clinically grounded multimodal LLMs.

Lingxuan Hou, Yuhua Xie, Yue Hu +14

College of Biomedical Engineering, Sichuan University, Chengdu, Sichuan, China · School of Engineering, Computer & Mathematical Sciences, Auckland University of Technology, Auckland, New Zealand · Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China +2

Medical VQA Medical VLMs VLM Reasoning Medical Image Benchmarks

Sep 3, 2026cs.CV

MetaStructAtlas: A Grounded 3D Vision-Language Dataset and Benchmark for Functional and Structural Reasoning in Whole-Body PET/CT

The joint interpretation of metabolic function and anatomical structure is essential for clinical diagnosis in whole-body PET/CT. Although recent advances in 3D medical vision-language models have demonstrated remarkable progress, current efforts are limited to regional CT imaging, leaving a critical void in comprehensive whole-body PET/CT analysis. In this work, we introduce MetaStructAtlas, a large-scale dataset for grounded whole-body PET/CT interpretation that synthesizes multimodal imaging with integrated anatomical, metabolic, and semantic annotations. MetaStructAtlas provides 490 co-registered 3D PET and CT volumes with 50,470 organ-level segmentation masks and grounded radiology reports. To facilitate interactive reasoning, we further developed MetaStructVQA, a standardized 3D grounded visual question-answering benchmark containing 100,565 QA pairs. This framework explicitly links diagnostic queries to visual evidence across modalities, encompassing anatomical, morphological, and metabolic characteristics. Finally, we evaluate state-of-the-art 3D medical VLMs on MetaStructVQA, establishing a robust foundation for multimodal representation learning and integrated whole-body reasoning in nuclear medicine.

Chenguang Zheng, Le Xue, Yichi Zhang +8

Huashan Hospital & Human Phenome Institute, Fudan University, Shanghai, China · Shanghai Academy of Artificial Intelligence for Science, Shanghai, China · Artificial Intelligence Innovation and Incubation Institute, Fudan University, Shanghai, China +1

PET/CT Imaging Medical VLMs Medical Image Grounding 3D VQA Medical Image Benchmarks

Sep 3, 2026cs.CV

MedQA-MM: Shortcuts Behind Medical Visual Reasoning

A benchmark score credits final answers, but not the route by which an item can be answered. In medical multimodal multiple-choice questions (MCQs), this distinction matters because a correct answer can be supported by the intended image finding or by benchmark-preserved cues in the wording of answers, non-visual clinical text, visible image text, artificial annotations, or device/context artifacts. We call the resulting score-level overinterpretation reasoning inflation. Here, a route is an observable input path that can support answer selection, not a claim about the model's hidden cognition. Across six medical multimodal MCQ datasets, we separate candidate cues from behavioral evidence through prompt- and image-side audits, modality ablations, and matched repairs that preserve the medical target and answer key. In a 13-configuration open-model panel, full-input accuracy is 62.63%, while text-only and options-only settings achieve 53.96% and 29.71%, respectively. Removing length-gap, absolute/conspicuous, and spatial/prepositional cues lowers accuracy by 6.58, 3.50, and 4.77 percentage points. We also construct MedQA-MM, a 1,000-item shortcut-mitigated subset, where text-only and options-only accuracy fall to 5.21% and 12.33%. This does not imply that models never use images; it shows that medical image-reasoning claims require route-level evidence.

Benlu Wang, Yifan Zhang, Jiaqing Yu +7

University of Massachusetts Amherst · 4Yale University · University of Massachusetts Lowell +6

Medical VQA Shortcut Learning Multimodal Model Evaluation Medical Image Benchmarks

Sep 1, 2026cs.CV

RadMatch: Auditable Radiology Report Evaluation via Finding-Level Matching

As AI systems are increasingly used to draft radiology reports, reliably evaluating their clinical quality remains a critical challenge. Large language model (LLM)-based metrics are now the best-correlated with radiologist judgment, yet they output a single opaque score that neither a clinician nor a model builder can easily interpret or audit. We introduce RadMatch, a multi-stage, LLM-based metric that decomposes report comparison into a structured finding-level matching with significance-aware scoring and error characterization across seven clinical attribute dimensions (status, location, severity, morphology, certainty, longitudinal comparison, and measurement). The main score is the actionable-error count, both interpretable and auditable. Candidate findings are graded correct, partial, or incorrect, and unmatched findings are counted as missed or hallucinated. Triage and actionable safety recall/precision and per-subset views add complementary, deployment-oriented lenses. Across two expert benchmarks, RadMatch is the most clinically aligned metric, matching inter-radiologist agreement on ReXVal and more than doubling the best prior metric on the harder RadEvalExpert. Relying only on few-shot prompting, it is designed to extend to other modalities and anatomies. We will release RadMatch as open-source code with an interactive dashboard for inspecting results.

Charles Corbière, Léo Machado, Aubin Charley +3

Raidium, Paris, France · Department of Radiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France · Service de Radiologie Interventionnelle, Département d’Anesthésie, Chirurgie et Imagerie Interventionnelle (DACI), Gustave Roussy, Villejuif, France

LLM-as-a-Judge Medical Image Benchmarks Radiology Report Evaluation

Sep 1, 2026cs.CV

A multicenter benchmark and clinically structured metric for coronary CTA report generation

Reliable evaluation of automated coronary computed tomography angiography (CCTA) report generation requires standardized multicentre benchmarks and clinically structured metrics. We established a four-centre benchmark comprising 3,021 CCTA series from 818 patient-report pairs to evaluate seven open-source three-dimensional vision-language models. We developed CSM

_{\text{CCTA}}

, a clinically structured metric for CCTA report evaluation, with patient-, vessel-, and segment-level variables defined according to clinical guidelines. Report pairs are compared at the finest shared anatomical level, and the contributions of different clinical components are weighted based on expert assessments. We estimated these weights using 70 expert-scored cases and evaluated clinical alignment in a non-overlapping set of 30 cases. CSM

_{\text{CCTA}}

showed a strong correlation with radiologist scores (Pearson's

r=0.97

,

p<0.001

), exceeding the next-best metric, FORTE (

r=0.70

), by 0.27, and agreed with expert preferences in 115 of 160 pairwise comparisons (71.9%). Under controlled perturbations, CSM

_{\text{CCTA}}

remained stable to clinically equivalent wording and decreased monotonically with progressive information omission. In the multicenter benchmark, the CCTA-trained C2RG model achieved the highest CSM

_{\text{CCTA}}

scores across all four hospitals, although its performance remained far from optimal. In contrast, CCTA-irrelevant reports accounted for up to 98.7% of the outputs from generalist models. Together, the benchmark provides a standardized setting for model comparison, while CSM

_{\text{CCTA}}

enables clinically structured evaluation of finding agreement and anatomical specificity. These results support a more clinically aligned and anatomically resolved approach to evaluating CCTA report generation. Code is available at https://openi.pcl.ac.cn/OpenMedIA/CSM_CCTA.

Zhiyu Ye, Yue Sun, Limiao Zou +7

State Key Laboratory of Biomedical Imaging Science and System, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China · Pengcheng Laboratory, Shenzhen, China · University of Chinese Academy of Sciences, Beijing, China +1

VLM Evaluation Radiology Report Generation Computed Tomography Medical Image Benchmarks Radiology Report Evaluation

Sep 1, 2026cs.CV

Benchmarking Vision-Language Models for Automated Pathology Diagnosis and Report Generation

The rapid advancement of vision-language models (VLMs) has accelerated progress in computational pathology; however, whole-slide image (WSI)-based pathology report generation remains limited by the scarcity of large-scale WSI--report datasets and the complexity of mapping spatially distributed visual patterns to structured clinical text. To address this, we introduce a clinically curated Pan-Asia WSI--report dataset of approximately 10,500 pairs from five institutions and establish the REG 2025 benchmark through a MICCAI challenge for systematic evaluation of multimodal models. We analyze submitted methods spanning pretrained VLMs, multiple-instance learning frameworks, hierarchical expert models, retrieval-augmented generation, and cross-modal Transformers. Rather than indicating that VLM use alone was sufficient for superior performance, the results suggest that top-performing methods benefited from structured report representations, hierarchical diagnostic decomposition, and effective multimodal grounding. We identify key limitations, including instability in quantitative attribute estimation (e.g., numeric hallucination) and a tendency toward diagnostic overspecification, with some errors resembling known diagnostic pitfalls in routine pathology. These findings establish REG 2025 as a benchmark for evaluating WSI-based structured report generation and vision-language understanding in computational pathology, providing insights for the design of clinically grounded multimodal pathology models.

Yumi Lee, Harim Oh, Hyoryung Kim +52

Computational Pathology Medical VLMs Medical Image Benchmarks Whole-Slide Image Analysis