Pathology VQA

VQA: Visual Question Answering

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16 papers3 papers in the last four weeks, against 2 the four weeks before. 0.0% of all new papers.

Oct 13, 2026

PlanPath: Exploration-Guided Orchestration for Patient-Level Pathology Reasoning

A patient's pathology case spans tens of slides from distinct specimens and anatomical sites, each carrying non-redundant, site-specific evidence. Forming a patient-level conclusion therefore requires locating the slides relevant to a given question and integrating complementary findings across them. However, existing pathology agents analyze one slide at a time and describe morphology rather than measure it, leaving evidence acquisition across a patient's specimens and patient-level quantification underexplored. To address this gap, we propose PlanPath, an agentic framework for patient-level pathology visual question answering (VQA). PlanPath turns the question into an exploration plan that specifies the evidence required, routes to the slides likely to carry it, and drives coarse-to-fine acquisition from tissue architecture down to individual cells. Tissue- and cell-level tools supply the counts, proportions, and extents, which PlanPath aggregates across slides into a traceable answer. To enable evaluation, we build two patient-level VQA datasets for renal and gastric cancer, averaging 15 WSIs per patient, with pathologist-verified question-answer pairs derived from diagnostic reports. Experimental results show that PlanPath outperforms the strongest baseline by 9.4% and 12.1% in overall accuracy on the two datasets and further improves existing slide-level agents when plugged into our framework. The dataset and code are available at: https://github.com/JSGe-AI/PlanPath_1.

Jiusong Ge, Mingzhao He, Qidong Liu +8

Xi’an Jiaotong University · University of Cambridge · A*STAR +1

Pathology VQA Medical VQA Whole-Slide Image Analysis

Sep 28, 2026

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

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.

Chengyang Zhang, Wenchuan Zhang, Bo Li +8

College of Computer Science, Sichuan University · Department of Pathology and Institute of Clinical Pathology, West China Hospital, Sichuan University · Department of Computer Science, School of Computing, National University of Singapore +1

Computational Pathology Medical VQA Medical VLMs Visually Grounded Reasoning Pathology VQA

Sep 26, 2026

Contamination, Prior, or Evidence? Decomposing and Training Evidence Use in Whole-Slide Vision-Language Models

Pathology vision-language models (VLMs) are conventionally evaluated by accuracy, but accuracy alone does not measure evidence use: it may conflate dataset contamination, prior knowledge, and image evidence. In a motivating study of lymph-node metastasis prediction, we found that most public pathology VLMs showed minimal differences when changing from feeding the models with whole-slide images, an annotated lesion, or no image at all. To better understand the specific features leveraged by these models, this paper presents two contributions aimed at disentangling these factors. First, we present CleanSlide, a TCGA-based VQA benchmark designed to eliminate image- and question-side contamination. It contains 149K audited multiple-choice questions over 9,985 slides, with patient- and tissue-source-disjoint splits. Every question is audited for option shortcuts, stem leakage, cross-split duplication, and blind solvability. Second, we propose Pair-DPO, a preference loss over counterfactual slide pairs from the same question and source. By controlling for shared confounding factors, Pair-DPO cancels out the question-attributable signal and leaves image evidence as the source of preference. Specifically, each pair consists of two real slides with opposite, verified findings, introducing neither editing artifacts nor unverified labels for diffuse or graded features such as invasion, necrosis, and tumor grade. Experiments show that our method gains 15.29% from image evidence on the CleanSlide, compared with 2.81% for the best published model. On the external CPTAC and BCNB cohorts, our method achieves accuracies of 57.6% and 59.0%, outperforming all other evaluated models by 9.7% and 3.4%, respectively. We will release the benchmark and code.

Wenhao Zhang, Zhongliang Zhou, Shiyuan Zhang +6

University of Virginia, Charlottesville · Merck & Co., Inc.

Pathology VQA Medical VLMs Medical VQA Whole-Slide Image Analysis Direct Preference Optimization

Aug 31, 2026

SlideBank: A Persistent Hierarchical Evidence Bank for Consistent Whole-Slide Reasoning

Whole-slide images (WSIs) are challenging for vision-language reasoning because diagnostically relevant morphology is sparse, heterogeneous, and distributed across gigapixel-scale images and multiple spatial resolutions. Existing WSI models and pathology agents can aggregate slide features or actively acquire evidence, but the information retained after exploration is often difficult to access semantically while preserving its connection to the original visual evidence. We introduce SlideBank, a training-free framework that represents each WSI as a persistent, concept-indexed, and spatially grounded evidence bank. SlideBank performs question-independent coarse-to-fine exploration to identify informative regions and multi-scale views, converts them into explicit morphological observations, and grounds pathology signals to their supporting patches and WSI coordinates. At inference time, questions are routed to relevant signals and evidence scales, and the linked global, regional, and patch evidence is integrated through confidence-based cross-level consensus. Experiments on WSI-VQA and SlideBench-BCNB show that with Patho-R1, SlideBank reaches 52.77% on WSI-VQA and with Quilt-LLaVA, it reaches 50.92% average accuracy on SlideBench-BCNB, while structured signal-guided retrieval consistently outperforms random evidence sampling. Reusing the same bank across repeated queries further achieves over 99% rephrasing consistency and substantially reduces amortized inference cost through persistent evidence reuse.

Beidi Zhao, Gexin Huang, Ciro Zhang +6

University of British Columbia · Vector Institute · Harvard University +3

Memory-Augmented VLMs Medical VQA Medical Image Grounding Whole-Slide Image Analysis Pathology VQA

Aug 26, 2026

VIPER: An Expert-Curated Benchmark for Vision-Language Models in Veterinary Pathology

Pathology vision-language models are advancing rapidly, yet existing benchmarks remain focused on human tissue, particularly oncology, leaving non-human pathology largely unaddressed. This gap is especially important in toxicologic pathology, where microscopic tissue examination of laboratory animals is a core component of preclinical drug safety assessment. To address it, we introduce VIPER, the first expert-curated benchmark for vision-language model evaluation in toxicologic pathology. VIPER contains 1,251 questions associated with 419 H&E-stained rat histology images across seven organ systems, covering multiple-choice, KPrim, and free-text formats. All questions were curated and validated by board-certified veterinary pathologists. In total, we benchmarked 16 models, including two newly introduced veterinary-pathology models, seven human pathology-specialized models, and seven general-purpose frontier models. The results identify a substantial domain gap between veterinary and human pathology, expose the risk of over-diagnosis of normal tissue in frontier models, and show that domain-specific training remains critical for visually grounded predictions. VIPER data and evaluation code are available at https://github.com/mahmoodlab/viper.

Luca L. Weishaupt, Simone de Brot, Javier Asin +9

Harvard-MIT HST · Mass General Brigham · Harvard Medical School +6

VLM Evaluation Pathology VQA Computational Pathology Medical VLMs Pathology Foundation Models

Aug 18, 2026

PathoArgus: Advancing Evidence-Grounded Long-Context Visual Reasoning across Gigapixel Whole-Slide and Multi-Slide Case Contexts

Whole-slide pathology reasoning requires models to integrate gigapixel-scale visual evidence across complete case-linked slides, yet current question-answering benchmarks primarily measure final answer accuracy--a metric vulnerable to linguistic priors and benchmark regularities, and insufficient to establish that predictions are grounded in the supplied tissue. We introduce PathoArgus-Bench, a benchmark and evaluation protocol that explicitly tests the full evidence chain: availability, accessibility, use, and responsiveness. PathoArgus-Bench comprises 22,078 four-choice questions from 4,913 patients across 15 TCGA projects, covering six pathology capabilities across three levels of evidence demand, and operates under a fixed reader budget that retains only a small fraction of the gigapixel context. To further isolate evidence-grounded reasoning, we contribute ESG (Evidence State Quartets), a controlled set of 483 quartets where the question text is fixed while the target WSI set is moved, replaced, or removed, requiring consistent predictions across all states. Evaluating 20 general-purpose, medical, and pathology-specific systems reveals a stark gap: while GPT-5.6 achieves 57.09% overall accuracy and 57.04% on ESG, it correctly completes only 19 of 483 quartets (3.93% QExact), exposing that row-level accuracy does not translate into reliable evidence grounding. We also introduce PathoArgus, a fixed-budget reader that allocates context via question relevance and spatial coverage, attaining 50.39% overall accuracy yet only 1.86% QExact--demonstrating that improved context access alone does not ensure consistent evidence-based prediction. Our benchmark and diagnostics establish that acquiring useful whole-slide context is necessary but far from sufficient, and call for a shift from answer-centric to evidence-grounded evaluation in computational pathology.

Bowen Liu, Qixiang Zhang, Xiaomeng Li

The Hong Kong University of Science and Technology

Pathology VQA Medical VQA Medical Image Benchmarks Whole-Slide Image Analysis Visual Question Answering

Aug 9, 2026

Agentic Visual Reasoning in Whole-Slide Pathology Images via Active Perception

Whole-slide visual reasoning requires identifying sparse diagnostic evidence in gigapixel pathology slides and integrating observations across spatial scales. Existing WSI methods either compress densely sampled patches into global representations or use pretrained vision-language models with heuristic region selection, weakening links between predictions and morphology or lacking pathology-trained observation policies. We present AdaptivePath, an active-perception framework that formulates WSI evidence acquisition as sequential decision making. The Navigator learns question-agnostic abnormality-driven navigation from pathologist-reviewed labels to select observation locations and spatial extents, avoiding costly question-specific trajectory annotations. We train this policy through alternating representation learning and proximal policy optimization, followed by fine-tuning with geometric and appearance consistency objectives to stabilize focus trajectories. During inference, the Navigator hierarchically acquires sparse observations from low to high magnification under a limited ROI budget. A Morphology Interpreter converts observations into question-conditioned evidence, while the Deliberator evaluates evidence and revises intermediate answers across magnifications. The Arbiter integrates deliberation history to produce final answers. AdaptivePath achieves state-of-the-art zero-shot performance on WSI and region pathology VQA benchmarks and reaches 80.14% accuracy for cancer subtype classification across six TCGA cohorts. In a blinded diagnostic-utility study, pathologists using AdaptivePath-selected observation sequences achieve 82.9% accuracy. These results demonstrate that learned active perception enables effective and traceable visual reasoning over gigapixel pathology slides.

Jingyun Chen, Fengchun Liu, Linghan Cai +5

College of Computer Science and Technology, Harbin Institute of Technology, Shenzhen · School of Computing and Data Science, The University of Hong Kong

Active Perception Medical VQA Active View Selection Pathology VQA Whole-Slide Image Analysis

Aug 6, 2026

Beyond Relevance: Bayesian Evidence Acquisition for Agentic Whole-Slide Image Reasoning

Whole-slide image (WSI) reasoning requires an agent to sequentially acquire visual evidence before answering a diagnostic question. Existing training-free agentic frameworks formulate this process as iterative patch retrieval based on semantic relevance to the question. However, semantic relevance does not necessarily imply diagnostic informativeness in computational pathology, where competing diagnoses often exhibit similar and overlapping morphological patterns, making many patches semantically relevant yet diagnostically non-discriminative. Consequently, relevance-based retrieval may acquire redundant observations and leave diagnostic uncertainty unresolved. We propose BEACON, a plug-and-play agentic framework that reformulates WSI reasoning as a Bayesian evidence acquisition problem. BEACON maintains a probabilistic belief over competing diagnostic hypotheses and sequentially acquires patches by maximizing expected information gain (EIG) to reduce diagnostic uncertainty. An evidence controller then determines whether to answer, acquire additional evidence, or perform higher-resolution inspection. Built entirely from off-the-shelf foundation models, BEACON requires no additional training or fine-tuning. Extensive zero-shot experiments across five WSI-VQA benchmarks demonstrate that BEACON achieves the strongest overall performance among training-free agentic frameworks while substantially improving evidence acquisition efficiency, establishing Bayesian evidence acquisition as a principled paradigm for uncertainty-aware agentic WSI reasoning. The code is available at https://github.com/bryanwong17/BEACON

Bryan Wong, Xun Xu, Huazhu Fu +2

1Korea Advanced Institute of Science and Technology (KAIST) · Institute of Advanced Intelligence and Computing (IAIC), A*STAR · Centre for Frontier AI Research (CFAR), A*STAR

Visual Question Answering Computational Pathology Medical VQA Whole-Slide Image Analysis Pathology VQA

Jul 30, 2026

PathView-Bench: Can Multimodal Large Language Models Achieve Fine-grained Multiscale Understanding of Pathology Images?

Multimodal large language models (MLLMs) are increasingly used to analyze pathology images. However, dominant multimodal benchmarks in pathology mainly score final diagnostic answers, captions, or reports. These evaluations provide limited insight into whether a model understands the multiscale visual content needed for pathology reasoning and decision-making. We introduce PathVU, a vision-anchored benchmark for fine-grained and multiscale visual understanding in computational pathology. Built from 23 public pathology imaging datasets with human-supervised labels and spatial annotations, PathVU evaluates MLLM understanding in two fields of view: Region FOV for high-resolution local regions and Slide FOV for macro whole-slide views. By converting raw annotations into deterministic task targets, PathVU enables programmatic scoring of region localization, visual recognition, quantity estimation, spatial reasoning, and insufficient-context judgment. The benchmark contains 14 VQA-style tasks, 61,673 images, and 308,070 samples across 28 organs and 7,253,526 annotations. Evaluating 18 representative general-purpose, medical-domain, and pathology-oriented MLLMs, we observe substantial limitations even in advanced models on fine-grained visual tasks across multiscale pathology images. PathVU provides a reproducible basis for developing and evaluating pathology MLLMs with explicit multiscale visual understanding.

Zongyi Chen, Yu Liang, Jie Lin +1

National Institute for Data Science in Health and Medicine, Xiamen University · Institute of Artificial Intelligence Xiamen University, Xiamen, China · Department of Computer Science School of Informatics Xiamen University, Xiamen, China

Computational Pathology Medical VQA Multimodal Model Evaluation Medical Image Benchmarks Pathology VQA

Jul 26, 2026

PathScale-R1: Cross-scale Reasoning for Pathological Image Analysis

Pathological diagnosis is inherently multi-scale, requiring the integration of global tissue architecture at low magnification with cellular morphology at higher magnification. However, existing pathology benchmarks and vision-language models (VLMs) are still largely developed under single-scale settings, limiting their ability to learn clinically meaningful multi-magnification reasoning. Moreover, naively constructed visual question answering (VQA) tasks may be susceptible to text-only or superficial visual shortcuts, leading to unreliable assessments of visual understanding. To address these limitations, we introduce a benchmark and training framework for shortcut-resistant cross-scale pathology reasoning. We design an Adversarial Text-only Screening strategy for semantic reasoning questions and a Structure-controlled Distractor Sampling strategy for visual grounding questions, encouraging models to rely on cross-scale visual evidence. Based on this pipeline, we construct PathScale-VQA, a high-quality cross-scale pathology VQA benchmark with 10,373 multiple-choice questions grounded in 1,368 diagnostic paths across multiple magnification levels. Building on the semantic reasoning set, PathScale-R1 is optimized through Difficulty-driven Reasoning Distillation supervised fine-tuning followed by reinforcement learning with a Scale-aware Reasoning Structure reward, which encourages the use of evidence across magnifications. Extensive experiments demonstrate state-of-the-art performance of PathScale-R1 on cross-scale reasoning tasks and effective transfer to conventional single-scale pathology VQA. Our code is available at https://github.com/iMVR-PL/PathScale-R1.

Chi Phan, Tianyi Zhang, Yufeng Wu +7

Department of Electrical and Computer Engineering, National University of Singapore, Singapore 117417 · Department of Biomedical Engineering, National University of Singapore, Singapore 117417, Singapore · Department of Pathology, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, Fuzhou, China +1

Computational Pathology Medical VQA VLM Reasoning Shortcut Learning Pathology VQA Medical Image Benchmarks

Jul 23, 2026

Do Pathology Vision-Language Models Truly See Pathology?

Pathology vision-language models (VLMs) have recently progressed rapidly and are commonly evaluated by answer accuracy on pathology VQA benchmarks. However, we dig into current evaluations and identify three overlooked issues: 1) Visual evidence is not always necessary. For instance, Gemini-3-Pro achieves 53.5% average accuracy across 5 VQA benchmarks without any visual input. 2) Domain training can improve accuracy without proportional gains in visual binding. Compared with Qwen2.5-VL-7B, Patho-R1-7B exhibits a 5.8-point lower multimodal gain and a 3.7-point lower attention IoU. 3) Entity-level attention is diffuse and weakly query-specific. On PathVG, attention maps remain highly correlated across different entity queries. These issues can lead to substantial misjudgments of pathology VLMs' actual multimodal capabilities. To this end, we present PathBind, a benchmark comprising 2,600 samples: PathBind-VQA with 1,500 questions across six dimensions, PathBind-PTA with 600 questions from a private pathology teaching atlas, and PathBind-Grounding with 500 expert-curated region-level samples. Each component undergoes task-specific automated filtering and expert review to reduce textual shortcuts and improve entity-region correspondence. We evaluate 18 representative VLMs on VQA samples of PathBind and five existing pathology VQA benchmarks, and further evaluate 10 VLMs on PathBind-Grounding and PathVG. Results show that current pathology VLMs still exhibit a substantial gap between answer-side performance and visual-semantic binding.

Chengyang Zhang, Wenchuan Zhang, Bo Li +10

College of Computer Science, Sichuan University · Department of Pathology and Institute of Clinical Pathology, West China Hospital, Sichuan University · Department of Computer Science, School of Computing, National University of Singapore +2

VLM Evaluation Computational Pathology Medical VQA Vision-Language Grounding Medical VLMs Pathology VQA

Jun 16, 2026

Enhancing Pathological VLMs with Cross-scale Reasoning

Pathological images are inherently multi-scale, requiring pathologists to integrate evidence from global tissue architecture at low magnification to cellular morphology at higher magnification for accurate diagnosis. While existing pathological datasets for vision-language models (VLMs) include various scales, they often lack explicit cross-scale reasoning objectives. This limitation prevents VLMs from capturing essential cross-scale representations and learning evidence-based reasoning. To bridge this gap, we introduce the first cross-scale training and evaluation paradigm that formulates pathology interpretation as multi-magnification reasoning. However, creating such a task reveals a critical challenge: multi-image visual question answering (VQA) is prone to text-only shortcuts, which allow models to guess answers using magnification-dependent artifacts rather than visual evidence. To address this, we propose a leakage-aware curation pipeline that combines adversarial text-only screening with constraint-guided question design. Using this pipeline, we construct Scale-VQA, a high-quality benchmark with 4,685 multiple-choice questions grounded in 2,537 pathology images across multiple magnification levels. Finally, we present ScaleReasoner-R1, a model trained via reinforcement learning to optimize performance on cross-scale VQA tasks. ScaleReasoner-R1 achieves state-of-the-art performance on our cross-scale reasoning benchmark and generalizes to SOTA performance on established single-scale benchmarks. Findings suggest that even the limited cross-scale supervision can significantly improve pathological understanding. Code is available at https://github.com/iMVR-PL/ScaleReasoner-R1.

Chi Phan, Tianyi Zhang, Qiaochu Xue +5

Department of Electrical and Computer Engineering, National University of Singapore, Singapore · PuzzleLogic Pte Ltd, Singapore · Department of Pathology, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, Fuzhou, China

Visual Question Answering Computational Pathology Medical VQA Medical VLMs VLM Reasoning Pathology VQA

May 22, 2026

PathNavigate: A Training-Free Pathology Agent with Surprise-Guided Scan and Shared Slide Memory for Whole-Slide Image VQA

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.

Chunze Yang, Qidong Liu, Wenjie Zhao +10

School of Comp. Science & Technology, Xi’an Jiaotong University · Tencent Jarvis Lab · University of Cambridge

Healthcare Medical VQA Tool-Using Vision-Language Agents Visual Search Whole-Slide Image Analysis Pathology VQA

May 5, 2026

DALPHIN: Benchmarking Digital Pathology AI Copilots Against Pathologists on an Open Multicentric Dataset

Foundation models with visual question answering capabilities for digital pathology are emerging. Such unprecedented technology requires independent benchmarking to assess its potential in assisting pathologists in routine diagnostics. We created DALPHIN, the first multicentric open benchmark for pathology AI copilots, comprising 1236 images from 300 cases, spanning 130 rare to common diagnoses, 6 countries, and 14 subspecialties. The DALPHIN design and dataset are introduced alongside a human performance benchmark of 31 pathologists from 10 countries with varying expertise. We report results for two general-purpose (GPT-5, Gemini 2.5 Pro) and one pathology-specific copilot (PathChat+) for sequential and independent answer generation. We observed no statistically significant difference from expert-level performance in four of six tasks for PathChat, 2/6 tasks for Gemini, and 1/6 tasks for GPT. DALPHIN is publicly released with sequestered, indirectly accessible ground truth to foster robust and enduring benchmarking. Data, methods, and the evaluation platform are accessible through dalphin.grand-challenge.org.

Carlijn Lems, Sander Moonemans, Natálie Klubíčková +53

Computational Pathology Healthcare Medical VQA Pathology Foundation Models Pathology VQA Medical Image Benchmarks

Feb 28, 2026

Act Like a Pathologist: Tissue-Aware Whole Slide Image Reasoning

Computational pathology has advanced rapidly in recent years, driven by domain-specific image encoders and growing interest in using vision-language models to answer natural-language questions about diseases. Yet, the core problem behind pathology question-answering remains unsolved, considering that a gigapixel slide contains far more information than necessary for a given question. Pathologists naturally navigate tissue and morphology complexity by scanning broadly, and zooming in selectively according to the clinical questions. Current models, in contrast, rely on uniform patch sampling or broad attention maps, often attending equally to irrelevant regions while overlooking key visual evidence. In this work, we try to bring models closer to how humans actually examine slides. We propose a question-guided, tissue-aware, and coarse-to-fine retrieval framework, HistoSelect, that consists of two key components: a group sampler that identifies question-relevant tissue regions, followed by a patch selector that retrieves the most informative patches within those regions. By selecting only the most informative patches, our method becomes significantly more efficient: reducing visual token usage by 70% on average, while improving accuracy across three pathology QA tasks. Evaluated on 356,000 question-answer pairs, our approach outperforms existing methods and produces answers grounded in interpretable, pathologist-consistent regions. Our results suggest that bringing human-like search and attention patterns into WSI reasoning is a promising direction for building practical and reliable pathology VLMs. Code is available at https://github.com/winston52/HistoSelect.

Wentao Huang, Weimin Lyu, Peiliang Lou +8

Stony Brook University, NY, USA · Mayo Clinic, MN, USA · Harvard Medical School, MA, USA +1

Pathology VQA Medical VQA Medical VLMs Whole-Slide Image Analysis

Feb 23, 2026

Hepato-LLaVA: An Expert MLLM with Sparse Topo-Pack Attention for Hepatocellular Pathology Analysis on Whole Slide Images

Hepatocellular Carcinoma diagnosis relies heavily on the interpretation of gigapixel Whole Slide Images. However, current computational approaches are constrained by fixed-resolution processing mechanisms and inefficient feature aggregation, which inevitably lead to either severe information loss or high feature redundancy. To address these challenges, we propose Hepato-LLaVA, a specialized Multi-modal Large Language Model designed for fine-grained hepatocellular pathology analysis. We introduce a novel Sparse Topo-Pack Attention mechanism that explicitly models 2D tissue topology. This mechanism effectively aggregates local diagnostic evidence into semantic summary tokens while preserving global context. Furthermore, to overcome the lack of multi-scale data, we present HepatoPathoVQA, a clinically grounded dataset comprising 33K hierarchically structured question-answer pairs validated by expert pathologists. Our experiments demonstrate that Hepato-LLaVA achieves state-of-the-art performance on HCC diagnosis and captioning tasks, significantly outperforming existing methods. Our code and implementation details are available at https://pris-cv.github.io/Hepto-LLaVA/.

Yuxuan Yang, Zhonghao Yan, Yi Zhang +6

School of Artificial Intelligence, Beijing University of Posts and Telecommunications, Beijing 100876, China · Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China

Pathology VQA Medical VLMs Whole-Slide Image Analysis Medical VQA Histopathology Image Classification