PathMMU: A Massive Multimodal Expert-Level Benchmark for Understanding and Reasoning in Pathology

Yuxuan Sun, Hao Wu, Chenglu Zhu, Sunyi Zheng, Qizi Chen +9 more
2/14/2026

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Abstract

The emergence of large multimodal models has unlocked remarkable potential in AI, particularly in pathology. However, the lack of specialized, high-quality benchmark impeded their development and precise evaluation. To address this, we introduce PathMMU, the largest and highest-quality expert-validated pathology benchmark for Large Multimodal Models (LMMs). It comprises 33,428 multimodal multi-choice questions and 24,067 images from various sources, each accompanied by an explanation for the correct answer. The construction of PathMMU harnesses GPT-4V's advanced capabilities, utilizing over 30,000 image-caption pairs to enrich captions and generate corresponding Q&As in a cascading process. Significantly, to maximize PathMMU's authority, we invite seven pathologists to scrutinize each question under strict standards in PathMMU's validation and test sets, while simultaneously setting an expert-level performance benchmark for PathMMU. We conduct extensive evaluations, including zero-shot assessments of 14 open-sourced and 4 closed-sourced LMMs and their robustness to image corruption. We also fine-tune representative LMMs to assess their adaptability to PathMMU. The empirical findings indicate that advanced LMMs struggle with the challenging PathMMU benchmark, with the top-performing LMM, GPT-4V, achieving only a 49.8% zero-shot performance, significantly lower than the 71.8% demonstrated by human pathologists. After fine-tuning, significantly smaller open-sourced LMMs can outperform GPT-4V but still fall short of the expertise shown by pathologists. We hope that the PathMMU will offer valuable insights and foster the development of more specialized, next-generation LMMs for pathology.

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@article{sun2026pathmmu,
  title  = {PathMMU: A Massive Multimodal Expert-Level Benchmark for Understanding and Reasoning in Pathology},
  author = {Yuxuan Sun and Hao Wu and Chenglu Zhu and Sunyi Zheng and Qizi Chen and Kai Zhang and Yunlong Zhang and D. Wan and Xiao-Da Lan and Mengyue Zheng and Jingxiong Li and Xinheng Lyu and Tao Lin and Lin Yang},
  year   = {2026},
  eprint = {2401.16355},
  archivePrefix = {arXiv},
  url    = {https://arxiv.org/abs/2401.16355},
  journal = {ECCV 2024 2024}
}

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