CPathAgent: An Agent-based Foundation Model for Interpretable High-Resolution Pathology Image Analysis Mimicking Pathologists' Diagnostic Logic

Recent advances in computational pathology have led to the emergence of numerous foundation models. However, these approaches fail to replicate the diagnostic process of pathologists, as they either simply rely on general-purpose encoders with multi-instance learning for classification or directly apply multimodal models to generate reports from images. A significant limitation is their inability to emulate the diagnostic logic employed by pathologists, who systematically examine slides at low magnification for overview before progressively zooming in on suspicious regions to formulate comprehensive diagnoses. To address this gap, we introduce CPathAgent, an innovative agent-based model that mimics pathologists' reasoning processes by autonomously executing zoom-in/out and navigation operations across pathology images based on observed visual features. To achieve this, we develop a multi-stage training strategy unifying patch-level, region-level, and whole-slide capabilities within a single model, which is essential for mimicking pathologists, who require understanding and reasoning capabilities across all three scales. This approach generates substantially more detailed and interpretable diagnostic reports compared to existing methods, particularly for huge region understanding. Additionally, we construct an expert-validated PathMMU-HR$^{2}$, the first benchmark for huge region analysis, a critical intermediate scale between patches and whole slides, as diagnosticians typically examine several key regions rather than entire slides at once. Extensive experiments demonstrate that CPathAgent consistently outperforms existing approaches across three scales of benchmarks, validating the effectiveness of our agent-based diagnostic approach and highlighting a promising direction for the future development of computational pathology.