Beyond the Failures: Rethinking Foundation Models in Pathology

Abstract

Despite their successes in vision and language, foundation models have stumbled in pathology, revealing low accuracy, instability, and heavy computational demands. These shortcomings stem not from tuning problems but from deeper conceptual mismatches: dense embeddings cannot represent the combinatorial richness of tissue, and current architectures inherit flaws in self-supervision, patch design, and noise-fragile pretraining. Biological complexity and limited domain innovation further widen the gap. The evidence is clear-pathology requires models explicitly designed for biological images rather than adaptations of large-scale natural-image methods whose assumptions do not hold for tissue.